“My narrative reflection

My name is Muriele Francois. I have been a RN for eight years. As medical surgical nurses, our team cares for acutely hurt patients; we treat them, and sometimes alleviate their suffering and refer them to the clinic for follow up. I never take time to consider what is goes on in the clinic until my rotations at King county pediatric clinic for Community health nursing this semester. This class has had a very great impact on my professional life. I have always loved working as a medical surgical nurse in a hospital setting. However, since the second day of my clinical rotation at Kings County when the nurse manager greeted us saying “welcome to our preventive care unit,” my perception about nursing has changed. Nursing is not only caring for ills; but also about the prevention of diseases. During these clinical rotations I tried my best to accomplish the objectives suggested by the syllabus in the following manners.

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

Professionalism was demonstrated by my punctuality and perfect attendance. I always dress appropriately, in addition, to wearing my lab coat and ID badge at all times. Confidentiality was maintained by never mentioning the identity of caregivers nor clients during preclinical conferences and blogs reports for lecture. As a student, I was not allowed to perform hands on care to patients but I took responsibility for my own learning by observing carefully the interactions between the caregivers and the clients. And I made sure to later ask questions for more understanding of the rationale behind each action. I meet with my clinical group and discuss the community project, in a professional manner, as colleagues would at work.

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

On a daily basis, I assess, diagnose, plan, implement and reevaluate my clients in the hospital I work; however during my learning experience in this clinical rotation, I was able to see not a difference, per say, but the expansion of duties between an acute and a community health nurse (CHN). I employed analytical reasoning and critical thinking skills when the care giver that I shadowed asked me questions such as: how would you address this situation? What should be your priority in this case? What information you need to further assist the client?

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

Working as a community nurse requires excellent assessment, communication and documentation skills. As a CHN student I was able to assess not only clients and families but the community as a whole. I learned from my clinical site that the first step in communication is to have a quick assessment of who you are going to communicate with. It is also important to have your resources and tools ready, such as translators, pamphlets in different languages, referral cards with manes, address and phone numbers because certain information must be given in writing to avoid misunderstanding. At the clinic, I was exposed to more diverse groups than I usually am at work, which was rewarding and informative. It was very important to me to learn more about all the available resources in the community, for referrals and regarding the health of the clients and their families.

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

Although, many of the viruses and bacteria that cause illness such as Measles, Diphtheria, Mumps, Pertussis, Rubella, smallpox, Polio and Tetanus are no longer reported in our community, this does not mean they are extinct. Therefore, my clinical group at Kings County found it very important that children of this community receive the recommended immunizations, at the right time. With the help of the instructor, we developed a teaching project on vaccination. We taught all necessary information to parents and guardians about vaccinations, in order to get them and their loved ones protected against deadly diseases.

– Our teaching plan objectives were to:

Provide information about communicable diseases that can be prevented with vaccines.
Teach the community about signs and symptoms of these diseases, who is susceptible, and how they are spread between people.
Inform the community about “Vaccine Basics” including information on the vaccine, who should receive it, and how many doses are recommended.
Direct clients to resources to get vaccinated.

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

Technology was utilized to provide information during the teaching sessions. Information distributed during the project was printed from CDC websites to make sure that good evidence based information is being delivered. I kept any information I learned about clients and their families confidential.

Objective 6: Demonstrate a commitment to professional development. .

Being a community health nurse requires passion, commitment and courage to pursue the healthy people 2020 objectives. Commitment to professional development is demonstrated by making it my passion to assess which health topic is the most important one to discuss with client during care delivery. In addition, continuing my education is a sign of commitment to my professional development. I am learning more skills in order to become better prepared, to be more involved in the development of a healthier community.

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

Since the first day of clinical instructor had reviewed with us all the policies of the hospital and I complied with them throughout the semester.

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

Collaboration with health care team was demonstrated by getting permission from my preceptor prior the implementation of any duty. Clients and families’ needs were identified with them by listening to their concerns. Clients’ preferences are considered key in many occasions, when formulating care plan. Community health nurse discuss plan of care with clients and gave referrals to other disciplines such as social worker, dietician, physical, occupational or respiratory therapist. Team work was key at this clinical site.

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

My clinical site is Kings County Ambulatory Care Center located in the East Flatbush area of Brooklyn. According to the U.S. Census 2000/NYC Department of City Planning, this community has a population of 316,700 people. It has higher portion of black residents than both Brooklyn and New York City, overall. More than half of Flatbush residents were born outside of the US. In Flatbush, 42% of residents age of 25 and higher has some college education. The percentage of residents living below poverty level is lower than Brooklyn overall.

Heath wise, the NYC Community Health Survey (2003) reported that less than one fifth of adults in Flatbush consider themselves to be in fair or poor health. In Flatbush, 10% of adults have diabetes. More than half of Flatbush residents (51%) report doing no physical activity at all. Only one third of Flatbush residents (33%) report exercising at least 3 days a week. More than 1 in 20 adults in Flatbush suffer from serious psychological distress. Adults in Flatbush are less likely to have engaged in binge drinking. Immunization rate among older adults (36%) is much lower than the Brooklyn and NYC rates, and falls short of the TCNY target by 55%. One in 20 Flatbush adults suffers from asthma. The rate of gonorrhea diagnoses in Flatbush is almost twice the NYC overall rate.

These information give me deeper insight on how to address issues of the community such as health education, health insurance benefits as well as project to assist clients in the promotion of a healthier generation. On any occasion that I have, I promote healthy behaviors to reduce risk for acquired diseases such as hand washing, vaccination, screening test, regular and annual physical, safe sex practice against diseases or unwanted pregnancy, smoking cessation, exercise, healthy eating. In addition, therapeutic ways to reduce stress instead of alcohol and drugs can be very helpful.

Conclusion

I have learned that to be an effective community health nurse, I need to be involved or have a deep understanding of what is happening in the community in order to take proper action to protect the welfare of the clients and families.

Reference:

nyc.gov/html/doh/downloads/pdf/data/2006chp-207.pdf”