SERVICE LEARNING PROJECT SELF REFLECTION

Clinical Site: Our Lady of Refuge Church

Objective 1: Demonstrates individual professionalism through personal behaviors appearance

During my clinical rotation at Our Lady of refuge Church at the weekly food pantry, my classmates and I conducted weekly blood pressure screening and BMI measurements. I maintained client confidentiality by complying with laws and regulations of HIPPA and the American Nurses Association code of ethics. As a patient advocate, I ensured privacy by speaking with and educating clients in privacy and away from the eyes and ears of other people partaking in screening. On our weekly recording sheet, we ensured that certain personal and demographical information was folded over and hidden, therefore, unseen by other clients. I assumed responsibility for my own learning by being aware of the pantry’s weekly objective, and also setting up the BMI measurement station. This was also a part of preparing for our clinical learning. My classmates and I would first meet with our clinical professor and the Community Nurse from Lutheran hospital to do a quick run through of what we would accomplish that day; as well as gather the products being handed out at the pantry and checking the nutrition facts to prepare for client teaching. Completing clinical assignments within a designated time frame is important because as a student, I am responsible for my works content and being accountable for handing it in, in a timely fashion. It is important as a new nurse to always seek the appropriate guidance, and I do so by turning to senior nurses (the community health nurse Susan, and the clinical Instructor Gellar); by asking appropriate questions, and gaining the proper knowledge, while implementing the proper clinical skills to ensure clients gets the best patient centered care. I participated in clinical conferences by answering questions, giving feedback, making suggestions, and working along with my student peers and volunteers at the clinical site. As a professional and a student, it was my duty and in my best interest that I was punctual in my attendance in accordance with the schools policy and I was certain to also put my best foot forward in dressing professionally each week, even though the food pantry was a very casual setting.

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

When providing care to the clients, we used simple interview to ask basic questions that focused on our objectives. Based on the answers the clients provided, we then employed analytical reasoning and critical thinking skills as far as obesity and high blood pressures were concerned. We did not have access to client’s personal medical records or direct contact with their primary health care providers. Upon assessment of the clients needs, it was apparent that culture and country of origin had a very strong impact on a client’s health status. Some clients believed that medications offered in the United States were not as potent and effective as medications offered in their country. So assessing barriers to learning was a big part helping our clients with noncompliance and achieving their maximum level of health. My classmates and I did not collect data as it related to our client’s self-care needs.  No complete head to toe physicals were completed on our clients, only blood pressure screening and BMI measurements. However, a few clients pointed out to us that they wish we had blood glucose monitoring at the food pantry. Prioritizing care based on collected data was crucial in our clinical setting. If a patient had extremely high blood pressure, we would ensure to repeat the measurements and emphasize the importance of complying with home BP medications, going to the emergency room, or following up with their primary health care provider. This went hand in hand with our nursing interventions, we would ask the patient about any related symptoms to high BP, educating on getting up slowly, and providing nutrition facts especially as it related to eating can meals which are loaded with sodium and preservatives. We did this in a safe and timely manner and with emphasis on follow up care, so patients can also recognize the seriousness of hypertension and obesity. My classmates and I did not participate in any medication administration. We evaluated nursing outcomes based on client’s feedback and improvement or lack of improvement based on weekly-recorded BP and weight measurements. This allows us to reflect on our practice, and lets us know if modifications are necessary based on our evaluations and progression in good health of client outcomes.  I instituted principles of personal safety in the community setting when helping patients to get on and off scales when measuring BMI. A lot of clients were elderly, and needed someone to help them with balancing when getting on and off the scale.

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

As a nurse, therapeutic communication is extremely important and necessary. It ensures that client feels comfortable with sharing their personal information with a “stranger”. It also enhances effective communication with individuals and their families because they become aware that we recognize them as a person and we want to act in their best interest. Listening, giving personal space, making eye contact, answering questions appropriately, and asking open ended questions made clients feel more comfortable and willing to offer personal information. It was imperative that we communicated significant data such as extremely high blood pressures to our clinical instructor and the community health nurse. They would then emphasize to the client the need to go to the hospital or follow up with their personal doctor. We adapted the proper communication skills needed, especially therapeutically, which enhanced care between the client and as student care providers. On our weekly recording sheet, we made sure to document what advice was given to the patient such as “follow up with PCP”, “continue medication regime”, “Continue daily exercise”, these interventions allows us to look back and ask clients what were their outcomes, and this lets us know how effective they were based on our evaluation.

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

A formal teaching plan was not implemented to our clients, however teaching materials were handed out to clients weekly. This included nutrition facts based on food given out at the pantry. A cooking class was also conducted for the students and the volunteers. We learned how to make certain meals from foods that are given out at the pantry often such as beans and tomatoes. We were taught the benefits of these foods to pass on the information to the clients we serve. We also handed out a paper that had a list of senior centers in and around that neighborhood that they could visit to possibly become members of. Since a lot of the clients were from low-income households, we figured they could benefit from this service for free meals and daily activities. The environment was not very conducive to learning, but when clients were truly interested, we took the time to step them to the side and teach them whatever it was they were interested in learning. Often times clients were solely interested in receiving the food and leaving. Learning outcomes were established as the clients and families demonstrated the knowledge and understanding they gained from the information we enforced weekly.

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

In our clinical setting, we did not utilize and did not find it necessary to incorporate principles of nursing informatics. All our information and data collected was recorded on paper and handed to the Community health nurse for patient confidentiality and data collection. However, we maintained strict confidentiality with client records, and teachings. This ensured their personal safety, and increased their desire to return for weekly screening, while sharing important information we need to provide the best care to them.

Objective 6: Demonstrate a community to professional development

 We incorporated current literature in planning care for our clients in the community setting by handing out up date pamphlets with information from the American Heart Association. Staying up to date ensures that we are enlisting the proper evidence based practice to our clients, keeping us confident in the information we provide. I assume responsibility for life long learning by continuing my education and keeping up to date on recent research and scholarly articles that support current care for clients. As a student and as a nurse, ongoing self-evaluation is needed in patient based client care. We have to continuously restructure how we handle patients and how we give them care based on the information at hand. Self-evaluation allows me to recognize my strength and my weaknesses and keeps me afloat of what I need to improve or what I need to continue to do. Knowing my strength and weaknesses helps me enhance my capabilities when it comes to applying my critical, theoretical, and clinical skills, which are all needed for my future within practicing this profession. Working in this community setting is helping me in my personal and professional development. I am not yet working independently, but it provides a framework and a blueprint which sets the groundwork upon which I accept the challenges to perform independently in the future. I am also well aware of the adjustments that are continuously made in the world of nursing.

Objective 7: Incorporate professional nursing standards and accountability into practice

It is extremely important that as a nurse we follow standards of clinical practice as they are set by the American Nurses Association; this entails providing adequate and safe patient care to the best of our ability and acting as a prudent nurse would. In doing so we foster the highest standards of care for the safety of the public. I believe I uphold these goals and standards, and I take pride in my responsibility and accountability that comes with the territory. I did this to the best of my ability, displaying much professionalism in my clinical setting. Working with Our Lady of Refuge associated with Lutheran Medical Center, the hospital’s mission is stated as “NYU Lutheran exists to serve its neighbors.  We are dedicated to caring for whole persons throughout whole communities.  As a stabilizing foundation for these communities, Lutheran is committed to meeting our neighbors’ changing physical, emotional, spiritual, intellectual and social needs”. I believe working with this elderly, low income, immigrant community mirrors the face of this mission, and we are exercising our power to help foster and meet the needs of this community.

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

At the food pantry, we did not get to collaborate with members of an interdisciplinary team; however we worked with volunteers who handed out canned foods and green produce, we worked alongside with Susan the community health nurse who is aware of the populations needs and shortcomings, in addition to this we worked with the person who applies for city grants and orders the food for the pantry. As “visitors” we had to be open minded, and allow them to show us how everything is done, before lending a helping hand. At the end of the day, each person working in the best interest of the clients had one goal in mind; and we were all able to collaborate effectively in achieving these goals. Our effective collaboration afforded us the opportunity to help meet patients needs by teaching about Hypertension and non compliance; with our therapeutic interventions, we were able to coordinate the best client based care we could implement. Most of the clients who visited the food pantry stated that they had primary care providers, and often told us when they last visited or when they will visit their doctor. A few clients were skeptical of telling their personal information, but we often informed them that if they needed emergency help they could not be turned down by community hospitals. Our main goal for this service learning project was to help facilitate these clients in being more compliant with medications secondary to hypertension, helping them make better meal choices with the food options offered at the pantry, and teaching them how to be partners in their own healthcare. My classmates and I achieve this through weekly reinforcement and education. The more we encouraged clients to take part in their healthcare, the more they stayed on top of weekly screenings. Even though they had no control of what foods were available at the pantry, we encouraged them to watch serving size, and ways to decrease sodium intake in certain canned foods. Most of them were receptive to our teachings. Within the first month of screenings at Our Lady of Refuge, we thought it would be a good idea to hand out Senior Center information to the clients. We thought this would be a great community agency for them to connect with because it also provides food and a place to be involved with other members of the community on a daily basis.

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

We must accept that there are numerous gaps in the healthcare system. Delivery of care is disrupted by many reasons, they include but are not limited to household income, immigration status, lack of health insurance, age, language barriers, mental and physical disabilities, preexisting morbidities, socioeconomic status, location, and the biggest one is lack of correct information. To overcome these disparities and close in on these gaps, we must inform the public. Providing the proper education in promoting self-wellness and living healthy lifestyle is the most effective way to ensure that the less fortunate can overcome certain disadvantages. As a patient advocate, as stated above it is my job to help inform the public and act in their best interest. This is all apart of providing high quality patient centered care.  It is extremely unfortunate that certain individuals lack the help they need because circumstances keep them from getting the resources they need. Health care providers must work alongside politicians and community leaders to lobby for patients rights and resources. Health care providers are at the forefront of the fight for equality in healthcare, and it is with this knowledge and power can the pendulum be swung in the right direction.