This semester I have had the pleasure of working within the Women’s Health Center and Pediatric Outpatient Care at NYC Health+Hospitals/Kings County in East Flatbush, Brooklyn. Each week I have applied the nursing process to provide comprehensive women’s health and pediatric care for members of this vibrant community. Here, I reflect upon the challenges and victories of the semester and self-evaluate my performance throughout.

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

Each clinical day I arrive a minimum of fifteen minutes prior to start time in business casual clothing, flat shoes, and with my equipment ready for use. With an understanding that I could be called to any walk-in clinic, I have my smile, flexibility, and eagerness available for immediate deployment. I seek out ways to expand my assignment so that I can hone and expand upon my current skills, but also to be of as much assistance to the facility as possible. Personal integrity is of the utmost importance to me. My day will never end without a sincere thank you to everyone who has allowed me to be present.

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

One major thing that I have learned from working in the community is how important resourcefulness and improvisation are. Gone are the days of ideal circumstances outlined in textbooks. With any number of fluid variables impacting community needs and available resources, getting the job done confidently and efficiently is paramount. With clinical understanding and experience with my own teenage nephew, I was able to assess a 14-year-old client whose chief complaint was a lingering headache. The standard questions were asked in triage: how long has this been occurring, what makes the symptoms improve or worsen, where is the pain located? The client’s one-word responses were typical for his age but I had an idea of what might be happening in the bigger picture. I asked how close he had to sit to the blackboard in school in order to see. He said that he has a lot of trouble seeing and with assigned seating he was unable to move closer. The nurse and I exchanged a quick look and proceeded to perform a quick vision assessment, the findings of which suggested that there was vision impairment that warranted further testing. The nurse made the recommendation of visiting an ophthalmologist to the client’s mother before sending the client to be seen by the pediatrician in the clinic.

I was proud of myself for thinking further than the presented symptom and for gaining the trust of this client to obtain the information we needed to get closer to the root of the problem.

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.

I have made a concerted effort to educate myself to become more culturally competent, especially in light of living and working in New York City. I believe that an effective tool for doing so is asking open-ended questions when appropriate, but more importantly listening to and observing what is explicitly stated or subtly implied. Additionally, I have had the honor of attending a school that is not only culturally diverse in its student base but also in its leadership and teaching staff. I am well aware that my race and ethnicity may initially create a chasm that needs to be bridged in order to provide proper care and hope that with respect, gentle humor, and genuine compassion I am able to do so.

A key part of the clinical experience this semester has been to identify a particular problem or issue that is relevant to the community in which we are working and provide an educational experience to address it. Our group chose to create a presentation on the flu vaccination in hopes of improving compliance with this important preventative measure. Through materials from the Center for Disease Control printed in the main languages spoken in the community (English, Spanish, and Creole), a vibrant poster with callouts addressing vaccine misconceptions and benefits, and one-on-one casual conversations between students and members of the community, we believe that we will provide tangible and clear information to help clients make more informed decisions.

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

By setting up within the lobby of the hospital setting during our educational presentation we will attract a lot of attention from clients and will hopefully be able to have a significant number of interactions. We understand that we will only have a few minutes to interact based on the setting, on having to be mindful of appointments or other timing, and on attention span of younger clients. Additionally, we have found that bright materials and having informational handouts in several languages will stir interest, priming clients for a quick learning session. We understand that information will need to presented in small, digestible bites in order for it to appeal and to ensure that it will be received. To further ensure that the vaccination information will be received and any questions answered, the entire group of students will be available to interact and teach. This one-on-one communication is also more conducive to learning.

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

When researching East Flatbush, we were able to use census and other government data in order to understand the demographics of the community. My fellow students and I used the NYC Department of Health and Mental Hygiene to further understand what issues may be facing the community. We were also able to share information using email communication and the discussion area on Blackboard.

Objective 6: Demonstrate a commitment to professional development.

By immediately pursuing a bachelor’s degree after obtaining my nursing license, I am committing myself to continually professionally and personally developing. I take every opportunity I am afforded to ask questions, learn new techniques or methods, self-evaluate, and receive feedback. I am devoted to my nursing profession and believe that the most effective way to keep current and prevent stagnation is through education. I have also joined the American Nurses Association and the New York State Nurses Association.

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

I believe that there is no greater honor than to be trusted by another human being when they are at their most vulnerable. Whether ill, in pain, or out of hope, this person in front of us is in need of help and to be the one to provide that help is a gift. It is our duty to protect the dignity and privacy of our clients, to provide equitable care, and to strictly adhere to our nursing ethics. My commitment is to my clients, full stop. I understand that my nursing practice is my own responsibility. As healthcare shifts from a traditional hospital setting to the community, it is my responsibility to follow with my practice and provide the same high quality care regardless of setting. Additionally, as healthcare needs change so will my scope of practice. I am committed to maintaining my education to handle these changes to fit the needs of my clients.

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

I was able to witness a very good example of communication breakdown between the physician and the client, and how the nurse was able to immediately intervene and clarify the situation. The client was experiencing an ectopic pregnancy and was given methotrexate four days prior to this visit. She had had no bleeding and during her visit she was given a scan, but the fetus was not able to be seen. She was under the impression that the physician wanted to remove her fallopian tubes entirely, however the physician was attempting to say that he wanted to perform an exploratory surgery to remove the fetus only. The client was understandably upset and confused. The nurse immediately went to the physician to clarify and gently say that the miscommunication had caused a great deal of stress to the client. The three went into an exam room, graciously asking me to wait outside, where the procedure was clarified and the client was supported and given the correct information. The opportunity to participate in and observe this particular event was highly impactful on my future practice and my ability to communicate.

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

There is a serious lack of equitability of healthcare services in this country. The availability and allocation of providers, services, and resources are all impacted by economic, political, social, and demographic forces. Some communities are seriously underserved and are instead reliant on poorly staffed and stocked clinics with inflexible hours. Insurance is often tied to one’s work, if it is provided at all, and is frequently insufficient to cover necessary care. But what happens to the person working multiple jobs who is unable to afford health insurance and cannot see a physician during the 9-5 office hours? The clinics in which I have worked this semester try to provide one Saturday’s worth of hours once a month but even this concession is insufficient for serving the community.

The Affordable Care Act has attempted to level the healthcare playing field in terms of accessibility and coverage, but resources are stretched too thinly to be fairly allocated. Whilst more people have some sort of coverage, there is still the issue of expanding the number of providers to keep up with demand. Chronically underserved communities are still underserved. Medical bankruptcy is still common. Prevention is ideal but oftentimes impossible when the main focus of the healthcare consumer is symptom treatment.

The shift to community nursing may ease some of the disparities simply by improving logistics such as location and hours served. Nurses can help lead the way with this initiative through our own education and expanding scopes of practice. Of course, this requires resources we often do not have ourselves in terms of funding and access to educational programs.

It is impossible to deny that there are severe disparities and inequities in this country with regards to healthcare. As a nurse, I am committed to my professional ethics that require fairness and equality. As an activist, I am committed to using my voice for those who have none. As a human being, I am committed to supporting my neighbor. As a student in the clinic, I am committed to listening and giving my whole self to provide the best care possible, full stop.