Marie Israel-Alceus

Self-Reflection

            For this semester (spring, 2015) I wanted to participate at a clinical site that was a little less traditional from what I was used to. I have chosen Public School (PS) 184 located at Brownsville Brooklyn as my clinical site because I wanted the opportunity and to experience working with children, and also to hopefully make a difference in the community overall. The opportunity for me to do my clinical session at PS 184 was great because it helped me to better understand the growth and developmental stages of 4-5 year old pre-schoolers. Also, I was able to gain plenty of knowledge regarding the Brownsville Brooklyn community. Our main focus for this semester was on nutrition and childhood obesity. In order for me to reach the goals of this clinical session, I must accomplish nine required objectives. The following is a list of these nine objectives in which I have described how I have accomplished and met each specific objective.

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

Before starting at the clinical site, my classmates and I  had to fulfilled New York City Department of Education (DOE) requirements by getting our background checked and fingerprinted done, these measures are necessary to protect the children. My classmates and I meets with the professor at 8am on Tuesdays at the school’s auditorium for group conference. During these conferences, we talked about planned activities for the children and address any issues that we might have. Though we are not at a medical clinical site, we still maintained the children’s confidentiality by not writing down identifying information on assessment sheets, and assuring not to capture their faces on pictures during activities. We pre-planned each activity before the next clinical meet up day. Our activities for the children include: an hour of physical activities during gym time, preparing nutritional meals for lunch, and drawing/coloring on educational worksheets. We seek guidance from the teachers when planning these activities, to make sure that our plans does not totally disrupt the children’s regular classroom routine. We dress in our nurses’ scrubs uniform along with our City Tech’s school identification badge. We preferred the scrubs so that we can feel comfortable and not worrying about getting dirty when participating in the activities.

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

Despite the fact that we did not have access to the children’s nursing and medical records, we did get in contact with the school nurse to find out if any of the students that are in the classes have any allergies and/or physical limitations that are going to impede or limit them from participating in the activities. When dealing with children, it was very important for me to understand the growth and developmental milestone of specific age groups. I reviewed the developmental milestone of 4-5 year old on the Centers for Disease Control and Prevention (CDC) website and other resources to gain more knowledge about what to expect. Understanding the growth and developmental milestone of 4-5 year old children, helped me to better communicate with them, planned activities based on what is expected from them at their age level, and to recognize appropriate behavior. We collected data by asking the children various questions such as: what type of food they enjoy eating, how often they go outside to play, and do they eat at restaurants or at home. In addition, we weigh and measure heights of each student to determent their Body Mass Index (BMI). We provide the parents with the BMI results and for the children with overweight BMI results, we provide the family with nutritional information, and also set up parent workshops to meet with them so that we can teach the parents how to make healthier nutritional choices. We did not administer any medication. The children eat their breakfast and lunches in the classroom, we made sure they properly washed their hands before they eat, we wiped the tables with disinfected wipes before laying the food trays on it, and we wore gloves when handling their foods.

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 very important when dealing with children. These 4-5 year old pre-schoolers are still trying to develop their language/communication skills; as a result, communicating with them can be a bit challenging. We communicate with them by using very basic words, speak slowly and clearly, stayed at eye level, we incorporated fun activities with learning, we showed them pictures of different foods to see if they can identify what is in the pictures, and also by reading stories that has teachable information. When we asked them questions, they know to raise their hands to be called on to answer. We also communicated with the children’s parent by sending them forms regarding the activities that their children were going to participate in and to indicate on the forms any food allergies that their children has. We communicated with the teachers about everything that we planned to do. At the end of each clinical session, the group meets with the instructor at the school’s auditorium to communicate our day experiences and also address any issues.

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

With the assistance of the teachers and my professor, my classmates and I were able to planned different activities for the children, our main goal were to educate the kids about healthy nutrition by maintaining a well balance diet and staying active. With the help of the teachers and the school staffs, we were able to use the classrooms and the school gym to conduct the planned learning activities. During many of our clinical sessions, we were able to utilize the classrooms for nutritional activities such as: coloring /drawing pictures of fruits and vegetables, reading books about cooking, making vegetable faces on plates, making vegetable soup, and cucumber sandwiches. We used the gym for one hour to do physical activities such as: tissue dancing, move like an animal, Easter egg relay race, Duck-Duck-Goose, Simon says, and melting snowman dance. The children really enjoyed both the nutritional and the physical activities because we were able to incorporated fun with learning. We were able to evaluate the children’s learning by asking them questions, such as to name 2 to 3 different fruits and/or vegetables, having them repeat what we say, and have them demonstrate things that were taught to them.

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

I was not able to use nursing informatics at this clinical area; however, I utilize the internet using my personal computer to gain information by conducting some research about the community of Brownsville Brooklyn. I researched the different resources that are available to the residents in the community such as, public services, food markets, healthcare facilities, schools, and/or parks/recreation centers so that I can share these information with the caregivers.  I also use the internet to research childhood development, nutritional and physical activity ideas for pre-school children. BMI and growth charts were used for the children and we used only the initials of their first and last name to maintained confidentiality.

Objective 6: Demonstrate a commitment to professional development

Practicing as a community health nurse independently is a very challenging task. Unlike the hospital where we go and practice under the umbrella of the hospital’s policies and procedures, however, the Community Health Nurse (CHN) is the eyes and ears of the community. The CHN is like a detective and is responsible to assess the needs of the community and to advocate so that the people in the community needs are met. Networking with other people is very important when working as a CHN because it can help in the time of need. It is also important to become members of professional nursing associations or organizations so that nurses can be well informed and to keep up-to-date with the profession.

Objective 7: Incorporate professional nursing standards and accountability into practice

Though we were not working at a traditional healthcare setting, however, I am still a Registered Nurse (RN) and it is very important for me to continue to represent the nursing profession by being accountable and professional as a nurse. I apply American Nurses Association Standards by practicing within my scope of practice. I complied with the school’s standard of practice by showing ID and signing in at the security desk before entering the building. DOE conducted background check and fingerprints before starting the program. My clinical instructor discussed all rules, regulation, and policies that we had to upheld while at clinical. The school staffs demonstrate professionalism, caring for the children, dedication, and depict what the school’s mission statement stands for. The mission statement for P.S. 184 stated: our mission is to prepare the youngsters in our school community to meet the challenge of the 21st Century. To accomplish this task we must teach all our youngsters how to learn and we must foster in all of them the desire for lifelong learning. We are committed to providing a safe and nurturing environment that every youngster deserves for his or her intellectual, emotional, ethical, social and physical growth. We must also instill in them an appreciation for cultural and ethnic diversity, so that they will become informed and productive participants in our democratic society.

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

Collaborating with the pre-schoolers was a great experience for me because I enjoy working with children. Though many of the children have no real knowledge regarding nutrition and obesity, they were very eager to learn and they always wanted to participate in all the activities that my classmates and I planned for them. Due to us just being at the school only one day a week, we were not able to really involve family members. However, we encouraged the children to share what they learned with their parents. The teachers at the school were very supportive and they were also a great sport for allowing us to come in and kind of change around their classroom routine schedule to accommodate us. As far as health care team collaborating goes, in my case that mostly involved working with my classmates, and the professor. We collaborate by participating and planning activities, researching the community for resources, keep close communication so that everyone stays on the same page, divide task so one will not feel overwhelmed with work.

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

While doing the community health assessment for Brownsville Brooklyn, I came to a realization that this community is one of the underserved areas in Brooklyn. There is a significant amount of health disparities or differences among the different group that exists within this community with regards to race, ethnicity, and socioeconomic status. According to the New York City Department of Health community health profile assessment of Central Brooklyn/Brownsville, the community of Central Brooklyn residents experience more barriers to health care access than those in New York City (NYC) overall, with nearly 3 in 10 without a regular doctor. Also, the percent of uninsured in Central Brooklyn nearly doubled between 2002 and 2004. In Central Brooklyn, adults are more likely to be obese (29%) than adults in Brooklyn (23%) and New York City overall (20%). In Central Brooklyn, 12% of adults have diabetes, compared to 9% in New York City overall (Olson, Van Wye, Kerker, Thorpe, & Frieden, 2006). Due to these health disparities that residents of Central Brooklyn are facing, I recognize the important of the teaching that we are doing as CHNs. It is imperative for us as nurses to instill in these children the important of healthy nutrition and to maintain good healthy habits at a very young age because these information can be use as lifelong learning tools so that they will be able to make better choices as adults in the future. During one of our clinical session, my classmate and I had a great opportunity to attend a presentation that was given by our other NYCCT nurses students to some very important stakeholders of the community. The nurses were proposing for an opening of a Boys and Girls Club in the community of Brownsville.

 

Reference

Olson E.C., Van Wye G., Kerker B., Thorpe L., & Frieden T.R. (2006). Take Care Central Brooklyn. NYC Community Health Profiles, Second Edition, 10(42):1-16.