Katarzyna Wojdyla

Narrative Self-Reflection

Fall 2016 semester gave me the numerous chances to develop my nursing skills. I was able to learn how to be a part of the community and how to bring my own contribution to it. Taking a Community Health Nursing Class allowed me to observe the work of the various clinics located at Kings County Hospital. Our clinical group could shadow the nurses who were providing the care to the patient of the different nationalities. The lecture and the clinical parts were strongly correlated to each other because the theory learned in the classroom could be used at the clinical site.

Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.

In my opinion, I demonstrated individual professionalism through personal behaviors and appearance. I did my best in order to meet all the criteria of the expected behaviors as stated by the syllabus. The first expected behavior was to maintain client confidentiality. I always remembered about HIPPA privacy rules when discussed the clients I saw. I never used the names during the post-conferences. Also, I made sure the doors were closed during the physical exams. The next expected behavior was to assume responsibility for my own learning. There were the times when we had few minutes between seeing the clients and I always used that time to talk to the nurses or doctors. I tried to extend my knowledge about the particular topic. The third expected behavior was to prepare myself for the clinical learning which I did by reading my textbook and assigned readings before going to the clinical. It helped me to be an active participant during the pre-conferences. The fourth expected behavior was to complete the assignments within designated time frame. The first assignment given to my clinical group was a windshield survey which was done on time. The second assignment was the discussion board and that was also submitted within time frame. The third assignment was a service learning project which is nearing completion. Another expected behavior was seeking guidance appropriately. I always tried to ask questions if I didn’t understand some aspect of care that I observed. I had many questions about the malignant breast tumor and it’s treatment therefore I asked the present doctor to help me to understand the whole process of diagnosis and therapy for this particular condition. Next expected behavior was to participate actively in clinical conferences which I did. I asked for the clarification on the subject if needed. Also, I shared my own observations if it was appropriate. The seventh expected behavior was to attend clinical punctually and in accordance with school policy. I am very strict with punctuality therefore I was always 10 minutes before the assigned time at the clinical site. Also, I was always dressed appropriate: business casual dress code, white lab coat with the visible ID attached which was complied to the eight and the last expected behavior.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

In my opinion, I was successful while employing analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. The first expected behavior was to use client interview, nursing and medical records, staff nurses and other health professionals to collect client information. As the professional  nurse, I used all possible methods to assess the client: I interviewed the client, I utilized the nursing and medical records that were available, and I asked the nurses and the other appropriate health care staff to gather the needed data. The second expected behavior was to assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status. I saw people of many nationalities with the different perspectives on life. I was always very tolerant and open for the discussion. Also, I tried to connect and find an agreement between the client’s own believes and the recommended standards of care. The next expected behavior was to collect significant data relevant to client’s self-care needs and I did that by assessing the clients and their reasons to seek a healthcare professionals’ help. I completed the physical assessment of the selected clients when I had a chance which is expected behavior number four. The next expected behaviors asked to prioritize care based on analysis of data and apply priority-setting in planning nursing interventions which I consistently executed with the help of the nurse. The seventh expected behavior was to implement safe, appropriate nursing interventions in a timely manner. I was always very careful, professional, and caring with all the clients. I intervened when the doctor asked me to assess the client without her permission. The client’s safety and satisfaction in a timely manner were my goals. The next expected goal was to administer medications and treatments safely. During the clinical, I didn’t have an opportunity to administer medications or treatments. However, I teached the client how to perform the breast self-examination. It was interesting that she never knew about it even if she was diagnosed with the breast malignant carcinoma few years ago. I showed her how to do it and asked to demonstrate it to her daughters. The same client helped me to fulfill the expectations of the next behavior: evaluation the outcomes of nursing care. She came back for her test results and I asked her if she did the breast self-examination. She did and found even more masses in her breast but what was very satisfying to me was the fact she brought her daughter to the clinic because she was able to feel something suspicious. The issue was discussed with the doctor. The tenth expected behavior was to be reflective about practice and to modify client care as indicated by evaluation of client outcomes. I did that by assessing and approaching the clients individually. Each client is different and their expectations may be peculiar therefore I always tried to find the thread of understanding with each unique person. The last expected behavior was to utilize principles of personal safety when working in the community setting. During every clinical visit with the clients I was following the standard precautions and asked for the permission before the assessment.

Objective 3: Effectively communicate with diverse groups and disciplines using variety of strategies regarding the health needs of individuals and families in the community setting.

 

In my opinion, I was successful to effectively communicate with diverse groups and disciplines using variety of strategies regarding the health needs of individuals and families in the community setting. I did all I could in order to fulfill the expected achievements. The first expected behavior was to utilize therapeutic communication skills with individuals and families in the community setting. I had a chance to had many conversations with the clients when I used my therapeutic communication skills but I will always remember one particular. The elderly diabetic patient tried to convince me and the other nurse she follows an appropriate diet even if her results were showing an extremely uncontrolled diabetes. She told us few facts about her life and I already knew her bad eating habits were caused by loneliness. The further conversation proved she is extremely uncomfortable being at home without anybody and the fact she retired her night-shift job contributes even more to her wrong eating-habits. I didn’t judge  or scolded her but I tried to give her few tips how to follow the proper diet. I fulfill the second expected behavior of  utilizing appropriate channels of communication by discussing any issues with my nurse and the clinical professors. I communicated clearly and effectively with instructor, peers and the health care team. I was always grateful to be among such professional and understanding people who was always able to give me enough time to explain, ask, and clarify my concerns. The next expected behavior was to communicate significant data to instructor and the health care team. My clinical instructor was very open and willing to listen to my observations. The health care team was extremely motivated to respect my opinions as well. The real challenge was to fulfill the next expected achievement to adapt communication skills to the developmental needs of the client. I had a chance to work with the numerous patients and all of them presented the different personalities. Some of them were very open for the discussion and recommendations some were more reluctant to talk. Overall, I was able to assess and teach the clients of the different backgrounds. I tried to use the appropriate language according with the knowledge level of the particular client. The last expected behavior was to report and document assessments and nursing interventions accurately. I didn’t have a chance to document the assessment but I always informed the nurse or the doctor of my findings.

Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.

 

In my opinion, I did fulfill the expected achievements to establish environment conducive to learning and use a plan for learners based on evidence-based practice. The first expected behavior was to develop and implement a teaching plan for an adult and/or family in the community setting. In a collaboration with the nurse, I was able to develop and implement the teaching plans for our diabetic patients. We assessed the clients, gathered all the data and created the appropriate teaching guidance for the clients. The same successful collaborative work was achieved with the clients who came for the prenatal care and with those who had the suspicious breast masses. As a professional nurse, I want my client to feel comfortable and be able to learn during the visit with the health care provider. Therefore, it is extremely important to provide a favorable environment for my client. It is very important to make sure the client feels safe and trusts the nurse. I used an appropriate vocabulary, calm voice and acted professionally so the client could carry out an informative lesson from the meeting. It is important to keep the door closed so the outside noises would not interrupt the conversation. My whole attention was focused on the client and her issue and I didn’t allow the outside influences to affect the visit. The third expected behavior was to evaluate client/family learning outcomes. I had  a chance to work with a male client who came twice to the diabetes clinic during my clinical rotation. The first time I saw the client, he wasn’t able to successfully follow the recommended diet which was proved by his poor lab values. The nurse and I gave him some useful tips how to control his blood sugar and his lab values improved by the second visit at the clinic.

Objective 5: Utilize informational technology when managing individual and families in the community.

 

In my opinion, I was successful to effectively communicate with diverse groups and disciplines using variety of strategies regarding the health needs of individuals and families in the community setting. I did all I could in order to fulfill the expected achievements. The first expected behavior was to utilize principles of nursing informatics in the clinical area. I used the computer to access the medical record of the clients. The system used by the facility is very clear and accessible. The other expected behavior was to maintain strict confidentiality with client records and I always used caution while obtaining the private information. I made sure the nurse logged out from the system when she wasn’t using it. Also, I was careful to not allow other clients to see the health records that were not theirs.

Objective 6: Demonstrate a commitment to professional development.

 

In my opinion, I successfully demonstrated a commitment to professional development by meeting all the expected criteria. The first expected behavior was to use appropriate current literature in planning care for clients in the community setting. As a group, we used the current statistics and research about this particular community during our pre-conferences in order to have a better idea with what community we will be working. We implemented the gained knowledge in building the care plans for the clients who visited the clinics. The next expected behavior was to assumes responsibility for lifelong learning which was also achieved by being informed about the characteristics of this particular community and working closely with the nurses I shadowed. Also, I read the posters visible at the clinical site to be updated with all coming events which could be helpful for the clients. Another expected behavior was to engage in self-evaluation. As a professional nurse, I want to progress and learn therefore every client was a new learning experience to me. We learned from each other. During the post-conference, I had a chance to discuss what I did that day and reflect on my performance. It allowed me to identify my strengths and weaknesses and give even better nursing care next time. The last expected behavior was to be committed to adjusting to the challenges of independent practice in community health nursing and I did it by fulfilling all the previous expectations.

Objective 7: Incorporate professional nursing standards and accountability into practice.

 

I believe I was able to incorporate professional nursing standards and accountability into practice by meeting all the expected criteria. I always utilize American Nurses Association Standards in my clinical practice and comply with agency standards of practice. It is essential to follow these two guidelines in order to provide the professional nursing care. Also, being accountable for actions in the clinical area and being aware of the assigned agency’s mission allow me to keep my clients safe and satisfied.

Objective 8: Collaborate with clients, significant support persons and members of the health care team.

 

I was able to collaborate with clients, significant support persons and members of the health care team during my clinical rotation. Every time I had an opportunity to see the clients, I collaborated effectively with health care team to address client problems. We worked as a team and learned from each other. Our goal was to provide the best quality of care. I coordinated client-care based on client needs and therapeutic interventions by helping the nurse to assess the client’s necessities and using the available tools to address them. I was able to  identify health care resources for client/families by asking the health care team the questions what other services are provided at the institutions that can be used by the clients. Also, I did some research on my won and used the information given to us by the clinical instructor. This way, I could share my knowledge of the available resources with the clients who needed it. That also helped to assist clients to make connections to other community agencies as well. The members of the community were able identify other options available in their neighborhood. The nurse is an educator and that’s why it was very important to me to guide clients/families to make appropriate lifestyle and treatment choices. It was very satisfying to be able to give some advices to the clients in order to improve their well-beings. Teaching about the healthy diet and how to do breast self-examination didn’t take too much time but definitely helped my clients.

Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.

 

In my perspective, I successfully recognized the impact of economic, political, social, and demographic forces that affect the delivery of health care services. There are many gaps in the care systems in our country. The hospital I had an opportunity to have the clinical, serve people of every background we can imagine. It is one of the city hospitals in NYC therefore provides care to uninsured clients as well which is extremely important. Thanks to the places like Kings County Hospital, people who don’t have a health insurance can receive a medical help when needed. My clinical group did the research and we were able to guide the clients how to utilize the available resources. We begun to identify solutions to complex problems in the clinical area. The clinical rotation allowed us to grow as the professionals and we could become the change agents in advocating to appropriate health care resources for client/families.

Narrative self-reflection wasn’t only an assignment given by the professor but a chance to go back to what I did during the semester and realize how powerful tools I have. Being a nurse gives me a chance to change people’s lives and using the clinical evaluation tool helped me to realize how I can do it even better. It is essential to know community and understand its difficulties so the nursing care can be efficient, safe, and quality-centered.