E-portfolio
The purpose of this self-reflective paper is to share my community clinical experience. Even though this is my first time to work in community setting as a nursing student, I have a better understanding of different nursing roles when dealing with clients/family, colleagues, and other health care providers. As a community nursing student, this is my experience how to meet my clinical objectives for the course.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
I understand maintaining patient confidentiality is a legal duty as well as an ethical duty, so that I am compliant with Health Insurance Portability and Accountability Act (HIPAA) requirements. I never discuss client’s information with classmates or instructor in public areas, only access to the data of that specific client who is assigned to me, maintain client’s privacy when post clinical experience on blogs or discussion board, etc. I am responsible for my own learning. I realize the best way to gain knowledge is practicing classroom theory in clinical or working environment. I always read my assignments and materials before clinical days, take notes and write down the questions I want to ask, or do some researches on the assigned topics via internet. I also finish my homework on time. Professors, preceptors, and other co-workers are resources for asking questions. I seek for guidance for “not-sure” things. During pre and post clinical conference, we share our stories, ideas, and opinions. I believe different perspectives and experience will contribute to develop better “client-caregiver” relationships. I never be late or absent for my clinical days. I will try my best to keep good attendance for the whole semester. Every time when I go to clinical, I dress appropriately and professionally because I notice that first impression is very important for building a trusting relationship. It tells other people I care about myself and respect them. Therefore, I would like to say I remain professional during my clinical experience.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
During interview, we gather subjective and objective data from patient, parents, and significant others. I was able to access computer records under supervision of the charge nurse. Nursing notes, provider’s notes, patient’s medical records, lab values, and radiology results are available to access. In this facility, I have been met clients with different background. I recognize that values and beliefs vary among different cultures, so that maintain respect and openness to the clients are very important. Be alert to how developmental, emotional, cultural, religious and spiritual influence on client’s health status. Access client’s self-care needs, and ask them the best way he/she thinks to resolve the problem. I believe we can make more effective nursing care plan in this way. Prioritize the problems based on the data we collected, tell the client the issues he/she should focus on, make next appointment to follow up and evaluate outcomes. We usually teach clients with s/p colposcopy the signs and symptoms need to report right away, such as heavy vaginal bleeding, fever, chills, an unpleasant vaginal odor, or lower abdominal pain, etc. For clients like to use tampons, they need to change to pads right after procedure because of the risk of infection. When this client comes back in 3 weeks for follow up, it is the time to evaluate the outcomes of nursing care and to see any part need to be modified. I was not able to complete a physical assessment of selected clients. However, I have observed my charge nurse to do the head to toe initial assessment on a one week newborn and 5 years old boy. Before administering immunization vaccines, I always explain to client/parents about side effects, and give VIS fact sheets of immunizations to them. I keep 6 rights in mind and follow institutional policy and guidelines to give vaccines. Make sure the right patient, right drug, right dose, right route, right time and right documentation. On the first day of clinical, we were already told about the disaster code and fire code. The charge nurse also showed me the locations of oxygen valve, fire distinguishers, and emergency stairs, etc. Personal safety and client safety should be concerned in the community setting too.
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.
When talking to clients and their family members, I try to remain nonjudgmental, listen actively, maintain good eye contact, and encourage clients to explore their experience. If I am not sure what they mean, I usually verify and clarify it. I never pretend I understand it when I don’t, especially when talking to client with language barriers, always use interpreters or language lines. Ask clients to verbalize what they perceive and encourage them to ask questions because communication is tow ways. Misunderstanding can lead to serious results. I communicate with my instructor, peers and other health care team member clearly and make sure they get what I mean. When parents came to me and reported the child had high fever or severe abdominal pain, I reported to the charge nurse immediately, so that they can make priorities to see the patients. When communicate with young children in pediatric floor, I understand that children communicate at different levels according to age and cognitive development. I am changing or adapting communication with appropriate terminology as needed but still communicate through presence, touch and eye contact as well as through verbal communication. The charge nurse review my “DAPE” (data, action, plan, and evaluation) notes before I type into the computer system to make sure it is accurate according to the facility’s guidelines and policy.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
I was very proud that I had a chance to participate in cardiac screen programs for children in the clinic. We decorated the waiting room with colorful balloons. We made the environment nice and clean so that clients would feel comfortable for learning. We also gave out some small gifts, such as crayons, pencils, etc. to those children who have done EKG. After evaluating by the cardiologists, parents received handouts which include general guidelines for taking care of high risk children. We allowed enough time and encouraged children and parents to ask questions. I believe each case is unique, so that different family will have different concerns. Develop client-specific or family-specific teaching plans. At the end of the section, ask clients to verbalize what he/she learned and encourage them to come back for follow up and further evaluation.
Objective 5: Utilize informational technology when managing individual and families in the community.
Nowadays, a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support nursing practice and delivery nursing care. In this facility, they have electronic medical records and everything is computerized. In the home screen, there are links to many reliable websites, for example, Lexicomp and up-to-date websites for drugs and clinical information, and computer page systems, etc. I can easily access the intranet and print out patient educational fact sheets to clients. I was told once we record the immunization administration in the computer, the information will automatically send to immunization registry of New York State at the same time. It is so convenient and fast. I maintain strict confidentiality with client records. When I am not using the computer or leaving nursing station or office, I always log off. Because I don’t have my own access to the computer in this clinic and I have to chart and document under supervision of my charge nurse, I only access the client’s information when my follow nurse is present.
Objective 6: Demonstrate a commitment to professional development.
I used the textbooks, current nursing journals, research articles, and other up-to-date literatures to help me plan cares for clients. I keep in mind that evidence based practice literatures are the best resources. I understand nursing is continuous learning process so that I have to keep learning to adjust to new technology and skills. I realize it is very important to have self-awareness which includes recognition of my bias, prejudices, and assumptions about individuals who are different, etc. In the community health setting, independent practice is more emphasized. For me, this is not an easy part. Teaching and advocator are two significant nursing roles in the community. I discussed breast self exam(BSE), baby-care safety tips, immunizations with clients, and helped some clients gather information about the special supplemental nutrition program for women, infants and children (WIC) and breast cancer society. Those experiences help me adjust to the challenge of independent practice.
Objective 7: Incorporate professional nursing standards and accountability into practice.
As a professional RN, I have to be responsible and accountable for my actions in the clinical area so that I always incorporate American Nurse Association (ANA) standards in practice. ANA provides information on professional nursing policy, code of ethnics, improving patient care environment, expanding our personal development, continuing nursing education, and so on. I also comply with this agency’s missions, values, and standards of practice. I ask my charge nurse or search the intranet for policy and procedures if I have questions.
Objective 8: Collaborate with clients, significant support persons and members of the health care.
As a part of interdisciplinary health care team, nurses need to collaborate effectively with other members. After taking client’s vital signs, I report the urgent signs and symptoms to the charge nurse and the providers so that they can evaluate them quickly. We access client’s needs and include their preferences when give recommendations. If they are agreed, we always encourage their significant support persons get involved in the care. For example, a woman came to clinic and complained that hypertension (HTN) was not getting controlled with medications. By asking her diet and other environment factors at home, we found out that her son loved fast foods so that she took him out once a week to eat and “have fun”. She verbalized she used to smoke a lot, but now she only smokes when she feels “pressure”. However, she replied that she feels pressure very often. Therefore, we recommended her cut down to go to those fast food restaurants and gave her son other rewards. When under pressure, try to do other things such as watch a movie, go to gym, etc, and decrease the total amount of cigarette smoking. This facility offers different kind of information for quitting smoking, dietetic control, children obesity, teenager pregnancy, STD prevention, etc. I help them to give out handouts, booklets, and schedules of workshops to clients who are interested.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
In today’s nursing world, economic, political, social and demographic forces have significant impacts. For instance, changes in Medicare & Medicaid service, cut down health care budget, new medical products and technology, etc., force health care providers to change and upgrade. In my opinion, those changes also create some problems and conflicts. In my working place, I voiced the concerns to supervisor and attended in-service conferences. In this clinical rotation, I noticed it is the similar situation. This facility also has meetings, in-service consults, and memos for changes or coming events. Everyone is welcomed to identify the problems and make good suggestions to solutions. We have to keep ourselves updated in order to appropriately advocate clients and families.
In conclusion, I believe I meet all the objectives of clinical performance. The interesting and different experience in community setting benefits me for personal and professional growth. It reinforces my knowledge and understandings of maintaining professional behaviors, practicing critical thinking skills, gaining effective communication techniques, and having self-awareness. I am looking forward for more opportunities to work in community.
