Introduction:
My clinical experience for NUR 4010, Community Health Nursing, took place at the Stein Senior Center. It is located at East 23rd street New York, NY, 10010. During the clinical, I was given a rare opportunity to be immersed in a learning experience. The center is located in a well to do neighborhood in Manhattan, and provides activities to promote health and wellness of seniors age 65 and older. Through my clinical experiences, I was able to learn about the role of community health nurse, the nursing profession itself, how clients cope with their unique conditions, and how to  work and engage this specific population within the community. In addition of conducting blood pressure screening and health teaching, assisting in the serving of lunch, we also supported the seniors in every way possible. I and my fellow nurses hosted a health fair to promote the health and wellness for the seniors, which introduced me with the concept of communication, ethics, resources and resource allocation and their impact on the provision of care and community.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
During my clinical experience at Stein Senior Center, I was able to demonstrate my professionalism as a registered nurse as well as a nursing student through my personal behavior. Every Wednesday, I reported to my clinical site at 9:00am sharp with a professional look. I have always treated my clients with their dignity and great respect at all time. I have to maintain my clients’ confidentiality during the interaction with other clients by talking about their health information personally. I took my responsibility for my own learning by reviewing the necessary information, participating in the conference, reaching out to the community members and most commonly reach out to the Professor who supported me through my whole experience; I was able to use my acquired knowledge to provide client care and complete a service learning –project in a team. At the beginning of each clinical, we had preconference and we discussed about our project, assigned team work, and took our assignments. At the end of each clinical, we had a post conference, where we shared our experiences of that day, discussed important issues related to our nursing practice and project.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
During my community assessment, I was able to use my reasoning skills and my critical thinking skills. One of my personal strength is to that I like to talk to people and learn about them. I used that skill with the elderly clients to collect clients’ information while I was taking their blood pressure, providing teaching about their medication and treatment regimen. I looked holistically at clients to assess the impact of developmental, emotional, cultural, and spiritual influences of the client. The surprising things were to me learning about significant data about these elderly clients’ financial struggles, self-negligence, and knowledge deficit on their disease process and treatment regimen. The experiences of incorporating analytical reasoning and critical thinking gave me an insight view that as nurses, critical thinking is embedded in our everyday routine. We use our critical thinking ability to identify a problem, determine the best solution and choose the most effective method of reaching that solution .I have experienced that  all sorts of practical skills in nursing school that we are putting to use at the clinic, but without the ability to think clearly and make rational decisions; those skills alone won’t get us very far .I always kept in mind that each client is unique, and I have provided teaching and care to each client based on her specific needs, cultural and educational background.
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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.
As a nurse I believe that therapeutic communication is essential for developing and maintaining effective nurse-patient relationships, and building a mutual trust. As my clients group was elderly population, and the members of Stein Senior Center are culturally diverse, I was aware of body language, wherether sitting or standing maintained my eye contact with them, made sure they have their assistive devices on if any, listen attentively and calmly.During blood pressure screenings I have the opportunity to speak with seniors on an one to one basis. I also have provided ample amount of time to express their concern, and used open -ended questions to encourage sharing their concern. In my culture, elderly are highly respected, so while I was with them I showed my respect to culturally diversely clients. I also have avoided medical terminology, and used simple clear statements while providing teaching. There were clear and effective communication with my professor and our team members in regards of our assigned work for the project, and feedback was always provided and appreciated to keep us on track.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
We established an environment conducive to learning to the seniors in the community. The service-learning project was created to educate about the health disparities affecting the clinical area and raise awareness. The health fair that we hosted was filled with opportunities for the seniors to learn and improve their health status. We also had one on one session to teach residents about their health and health related practice, while we have done blood pressure screening to the elderly. We have also reviewed their medication and provided teaching.l. Hosting a wellness health fair was meant to provide these seniors with available resources within their community, to make them more involved into their community and create more opportunities to learn more and improve their health status.
Objective 5: Utilize informational technology when managing individual and families in the community.
I have maintained strict confidentiality with clients’ information obtained during interviews and discussions. Though we did not utilize informatics heavily, there was some form of utilizing informational technology. We used computers and the web-based database to access and read information regarding clients, and the resources they have available to complete our project. We sent emails to vendors, inquired via the internet about resources in the area beneficial to the seniors, printed banners, and developed flyers for the fair that was mailed out to vendors with an invitation letter also created on the computer.
Objective 6: Demonstrate a commitment to professional development.
I was able to see the professional challenge that a community nurse would have to face by engaging myself into the service-learning project. We have done research and kept current with the issues that surrounded the community and its populations. We have utilized appropriate and  the most up-to-date literature search to  collect information to held a very useful and informative health fair.  I believe education is an ongoing process, especially in nursing field, we have to integrate evidence based practices into our professional activities. To do so, we assume responsibility for lifelong learning.  .
Objective 7: Incorporate professional nursing standards and accountability into practice.
Nursing professional standards have been incorporated during my clinical practices. I believe to provide appropriate, and compassionate nursing care, I should follow the professional nursing standards such as code of ethics, scope of practices and standard. As a nurse, my job is to provide the best available care and always act upon client’s advocacy. I always held my accountability for my actions during my clinical, and I am responsible to provide a highest level of care by maintaining a safe environment along with culturally sensitive nursing care.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
To provide effective and continuum best nursing care, nurses are in the perfect position to collaborate with patients and their families, healthcare members, and significant support person. I have always tried to reach out for resources that might benefit the clients group we have been cared for. We have to Effective collaboration and communication an important part of nursing practice.  Planning and hosting a health fair definitely a great example of collaborative effort. . The constant calls, emails, written correspondences, invitations and follow up were paramount. We have collaborated with community members to provide and inform the best resources to the seniors and reach out to government officials and businesses to persuading them to take part in our mission of promoting health and wellness for the seniors. I had the opportunity to help clients navigate the available health resources offered in the community and assisted clients in making connections with other health related agencies in the community.
Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
Through the service- learning project, I have learned and recognized the impact of economical, political, social, and demographic forces that affect the delivery of health care services. Although my community site is a wealthy community, but some seniors still deeply have financial battle that affect their health care. The rate of uninsured population is less compared to other  communities in NYC, but there are some seniors who are very tight on their budget. This results not to follow preventative regimen, less access to healthy food and create higher level of stress.  They have ample access to transportation. School, hospitals and medical centers are available. The leading health disparities in the community are increased rate of cancer, alcohol abuse, high incidents of HIV and higher number depressed population. Therefore, providing teaching and information about the resources available in the community would assist this group of population to raise awareness, to take preventative measurement for the disease process, and reduce the level of their daily stress. One way we established the help to the seniors by hosting a health fair. Having a health fair provides these seniors a great opportunity to learn about the resources they can use within their community to make their lives physically, emotionally and economically better.
Conclusion:
Taking this Community Health Nursing course assisted me in developing a new skill set that sometimes the same but often different than working in an acute care setting. The fundamentals of community-based care are the focus on health promotion, disease prevention and maintenance of health. To do so, a CHN must use the ability of critical thinking, a problem solving skills, and be able to create ideas about best practices for the future. Through my collaborative team work on hosting a wellness fair for the seniors, I have engaged in the process of thinking, feeling, and performing work in the community, and I have got a better understanding of the relationship between the clients- or community based needs, the system of care management, and the influences of resources allocations and their impact on the provision of care. Our main concern was to provide education to be safe and preventative perspective for the seniors. I strongly believe that community health nursing is an exciting, unpredictable and rewarding profession.
