Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
As a registered nurse professionalism isn’t only in the way that one may carry his/her self, it is more in-depth for the nursing practice. Professionalism is communication skills and professional conduct (attitude, mannerism, etc.). During the Spring 2014 I completed my clinical rotation Community Health Nursing clinical at Kings County Hospital Center at the Women’s Health Clinic and the Diabetes Clinic. Clinical started at 8:30 am until 12:40 pm at times we would have pre –conference and post conference, I made it a personal effort to be at clinical at the designated time because I did not want to delay any learning that the professor provided. Always wearing your clinical lab coat, dressing in the proper attire and wearing your ID distinguished us from the medical/nursing staff at Kings County Hospital Center as well as the patients/clients; no student was allowed to participate any clinical activities without proper attire. While serving this group of population confidentially was upheld to the highest degree much so that an in service class at the facility was done on the first day of clinical which we learned about confidentiality in the workplace, also not speaking about the patient or the patient’s condition in the elevators, hallways, nursing stations, etc. but only in post conferences among our peers and clinical instructor. The clinical instructor was available to us when needed although we were assigned to a nurse I actively seeked information from the nurses, nurse practitioners and charge nurse. For instance, I did not know what a colposcopy was, so I asked the nurse who discharged the patient if there was any information that I could receive regarding colposcopy the nurse was able to provide me with educational materials. As an astute nurse you have to be ready and willing to learn. I wanted to have a better understanding of the procedure so that if I was interviewing a client the follow week I would be able to provide teaching to the individual if he or she lacked knowledge. As a registered nurse you are always learning because medicine and evidence based practice are always changing. Assignments are always needed with teaching and learning, we were given assignments that would be due to the following week, we were expected to present or discuss assignment that was allocated to us.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Every Tuesday at Kings County Hospital, we were given the opportunity to interview a client before they saw the nurses or doctors while they were in the waiting area. During the first couple of weeks I was anxious to interview the clients because I did not know how they would perceive me asking those questions, but the clients were so personable that by the 4-5th week of the rotation I was able to interview the clients without any fear of asking questions medical needs to social needs. Information that was gathered during the interview was brought to the attention of the intake nurse and those issues would be addressed. During the interviews I was able to assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status. For example ,I interviewed a client who was referred by her primary care provided to breast clinic at the Women’s Health Center because of an abnormal mammogram, I asked the client if she was nervous she said she was not, because she is putting her trust in God and whatever the outcome may be she is ready to face it and her family and friends are there to support her. An important key that the clinic nurse stated is that each client that you meet even though their diagnosis are the same their treatment, attitudes differ so we have to be able to change the way we teach each of them. For example a 50 year old female with an abnormal PAP teaching maybe different in the way we approach a 25 year old with an abnormal PAP and this should be addressed by doctors and nurses. Unfortunately, I was unable to complete a physical assessment because we were not allowed in the examination room with the patient. Since most of the rotation was observational I was unable to prioritize care, applies priority-setting in planning nursing interventions, administer medications and treatment safety, and evaluate the outcome of nursing care. Personal safety while working in the community setting was conducted at all times.
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.
Communication is a key factor in nursing and the nursing practice. During the various interviews that I conducted during my rotation, I have learned that communication is fundamental with health care providers (e.g. nurses, doctors) especially when it deals with teaching and medication management. I have utilized therapeutic communication skills with the individuals in the community setting by allowing the clients to ask me questions, using open ended questions to provide further communication, providing feedback if necessary and having an open dialogue with the clients. An important factor in communication is non-verbal cues which can place a barrier within communication. Being personable to the health care staff, peers, and clients goes a long way. Various way in which communication was conducted with the clinical instructor and peers during our rotation were verbal communication, text messages, email, and telephonic communication. A lot of verbal communication was done with the health care team especially when we spoke to the nurses about the various clients we interviewed and if any issues arised during the interview. The nurse would adapt to communication skills to the developmental needs as needed; for example the nurse did not speak the client primary language (Spanish) so she used the cyracom phone which is a full-service language provider that focuses on healthcare and was able to complete a full assessment of the patient. I was not able to report and document assessments and nursing interventions accurately, however I was able to observe the nurse document educational materials provided to the patient upon discharge.
Objective 4: Establish environment conductive learning and use a plan for learners based on evidence-based practice
One of the main components in community health is teaching, teaching is a vital tool to the community because it provides knowledge to the patient and creates. The final project for community health nursing is a service learning project which is learning and teaching approach that integrates community services with academic study to enrich learning, teach civic responsibility, and strengthens community. The service learning project that is being conducted at focuses on diabetes management; as a group we developed and implemented a teaching plan for these groups of clients. The environment for teaching at the facility is conducive to learning because it is a private room with the nurse and the patient; they are able to speak privately in the room and discuss medical management and not violating HIPPA. The nurse is able to evaluate client learning outcomes by asking questions about the topic that was discussed and the client was asked to return demonstration as needed.
Objective 5: Utilize informational technology when managing individual and families in the community.
Unfortunately I was unable to utilize the principles of nursing informatics in the clinical area, because during the clinical rotation we mainly observed what the nurse did. However at Kings County Hospital all the clients information are recorded electronically; so the nurse had to make sure that they never leave the computer unattended while in the patients chart is open ,they must always close the screen or close the patient chart while the computer is left unattended.
Objective 6: Demonstrate a commitment to professional development
As healthcare professionals we have to always stay current with the various nursing trends, healthcare needs, disease management, etc. These goals can be achieved through research, journal articles, databases, and participating in groups or coalition that focuses on the issue that I am passionate about. Here at Kings County Hospital Center current literature was available by the use of pamphlet or educational materials. In adjusting to the challenges of independent practice is based on individuality and the willingness to adapt as the health care provider. As nurses we have to remember that we took an oath to provide quality, safe and effective care when that becomes compromised we have to self reflect and make sure that we understand the true value of nursing. The challenges that I faced during my rotation at Kings County Hospital Center were being able to communicate with the client overall and not just talking about medication and disease management. In the fall 2014 I will be obtaining my BSN, I have realized that I want to obtain my masters degree as a clinical nurse specialist or a nurse practitioner that focuses on disease management in diabetes and cardiac care and I will be providing my services to the underserved population. However I need more years of clinical experience and practice which I hope to obtain after receiving my BSN.
Objective 7: Incorporate professional nursing standard and accountability into practice
The American Nurses Association Standard into clinical practice focuses on the scope of nursing practice includes through assessment and diagnosis through verbal communication with the clients before they see the intake nurse. I was able to collect data while interviewing the patient and assess the information collected and diagnosis if there is a medical or social need that the nurse can assist the patient with. I complied with Kings County Hospital Center standard of practice for a nursing student; I am held accountable for my actions in the clinical area (e.g. patient confidentiality). The mission of Kings County Hospital Center is to provide quality healthcare to a culturally and linguistically diverse population regardless of their ability to pay.
Objective 8: Collaborate with clients, significant support persons and members of the health care team
I was able to achieve this objective by communicating with the nurse of the client social needs that may impact she/her medical needs. By communicating with the nurse, I was able to better understand how resources are allocated in the community setting. I observed the nurse teaching clients of various lifestyle changes and treatment choices that has positive impact on their disease progress. However the nurse was always listening to the client and providing feedback and respecting the client’s choices. At the women’s health clinic the nurse was able to make connections with other community agencies if the clinic did not offer services that is beneficial to the client. During the discharge of a patient, one of the patient stated that the commute to Kings County Hospital was not convenient to her; the nurse was able to have the client speak with the physician and hopefully having her case referred to another HHC hospital that is closer to her home.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
Kings County Hospital Center serves an underserved population of mostly undocumented immigrants. Even though the hospital mission is to serve any one regardless of ability to pay, most the clients only seek medical care when his/her disease is unmanageable by them or the symptoms are overwhelming ( e.g. pain). For example during our 4th week of rotation in the women’s health clinic, a 38 year old female who was 36 week gestation arrived to the clinic to get a prenatal workup; at this time she had to do a, about 1 hr into the patient fainted and a code was called, the clinic nurse told us that this is not unusual especially in the Haitian community, the expecting mothers will show up 3-4 wks before full term to get workup done with no prenatal workup done. The nurse stated that these mothers are fearful that they may get deported which is a common misconception. I would advocate for this venerable population by going to the various community centers, churches, etc and teaching about women’s health and pregnancy so that the word would go around that prenatal care is necessary and in any health care setting you should not have the fear of deportation. Financial and economic factors play a crucial role in preventative care in the United States.
