Clinical Self-Reflection
The clinical rotations are performed in a public school at Brownsville, Brooklyn, this schools presents different psychosocial and health disparities that required community health nursing. Many of the children from this school are coming from a disruptive family and some of them have one of their parents in jail or death. In addition, the neighborhood has a high level of violence and drugs. In an effort to met our nine objective for our class, we performed different interventions that included nutrition, anger-management, decision making, self-esteem and many others that definitely benefit this children in need.
OBJECTIVE 1: Demonstrates individual professionalism through personal behaviors and appearance.
The clinical site I am attending to for my community health nursing is the school PS 184. The population we are working with are children between the ages of 12 to 13 years old. Every Wednesday I arrive at PS 184 around 8:15 am to get together with the rest of the nursing student and then we head to the classroom to meet our mentee at 8:30 am. I dress my professional attired and wear my college identification at all the time during my clinical. My mentee is a 13 year old female and from the very first day of our encounter, it was explained to her that everything that we discussed was going to be confidential and her privacy was going to be maintained. In addition, at all the times that we have the opportunity to talk the approached implemented was in a very calm, respectful and in a caring manner. Furthermore, a clear communication using a vocabulary corresponding to her level has been utilized, during several discussions on different topics. Through a clear communication, she has been able to give a feedback on what she has learned and understood at the end of the conversation, allowing me to clarify and add information that she missed. It is important as well to be prepared, with the lesson we are going to provide in every clinical day, this give me the opportunity to be straight forward on the topics I want to cover, prevents from time to be wasted and permit her to obtain a informative and learning experience in a short period of time.
OBJECTIVE 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Analytical reasoning and critical thinking skills were constantly used with all the approaches implemented for them. These children are growing up in a violent neighborhood, many of them are coming from a disruptive family and some of them have one of their parents in jail. Therefore, from the very beginning we have to implement different approaches based on their situation to obtain their trust such as frequently explaining to them that their confidentiality and privacy was going to be kept. As we continued to spent time with them, we were able to recognize the different psychosocial needs, their family structure, neighborhood atmosphere, and psychological issues that they are experiencing, which allowed us to apply different interventions focusing on the issues recognized. One example of the interventions performed was the presentation done by me and 3 other classmates on decision making and anger management. We performed a skit on the benefits of making the right decision and preventing an aggressive reaction to a hostile situation, and then we allowed 3 students to carry out their own skit in a similar situation. We continued by explaining seven tips on decision making and ten tips on anger management and we finalized our lesson with a discussion, where children were involved. Throughout this discussion, a fruit salad was provided to each student to reinforce the lesson given the week before on nutrition. During this lesson we were able to teach, verify that they understood the content and review the previous lesson with them.
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.
The key was to implement a therapeutic communication for it to be effective, this type of communication allows us to demonstrate that we care and that we are implementing a non-judgmental approach, which definitely change their attitude and promote trust. At the beginning of the clinical in PS 184 when I started spending time with my mentee, it was very hard to obtain information from her, every time I asked her a question she will reply with minimal words like a “yes”, “no” or simply one word. I started using therapeutic communications techniques like silence or restating what she said. Slowly she started to give me more details during a conversation to the point where I did not have to ask anymore, she would come up to me and state “Ohhh I forgot to tell you last week”…. In addition, at the beginning she had an unreceptive attitude and she was constantly rolling her eyes, when I was attempting to teach her different topics. In an effort to prevent these attitudes, eye contact was maintained; I made sure that my verbal communication and my non-verbal communication were congruent and a caring attitude was always in place. She is now more receptive, sits down appropriately and maintains eye contact during a lesson and at the end she usually asks question if she does not comprehend something from the subject discussed.
OBJECTIVE 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
During the presentation on Decision Making and Anger Management, we involved on the lesson to keep their attention and to assess their understanding on the instructions given. We used different tools to evaluate their understanding. The first tool, as previously mentioned was that 3 students performed a similar skit to the one that we presented, then we have a discussion on the anger management and decision making tips, while they were having the fruit salad. In addition, we used a vocabulary congruent to their level to ensure comprehension. On the other hand, our lesson was done in 30 minutes; we intended to make it concise, in a small period of time but very informative.
OBJECTIVE 5: Utilize informational technology when managing individual and families in the community.
When we were planning our lesson, we first thought of doing a power point presentation. The classroom did not have a projector available for the presentation to be done that way, instead we have to request one and if it was available they would allow us to use it. As result, we decided to perform the skit and to do 2 big boards with the Decision making and Anger Management tips for our teaching project.
OBJECTIVE 6: Demonstrate a commitment to professional development.
Part of our commitment to our professional development is to be prepared for our clinical day, knowing what is going to be done and having a plan of how it is going to be performed. This will help us to implement a better practice, while obtaining the necessary skills that we need to acquired. In addition, constantly research on evidence-base practice to improve all the techniques and skills that we already have, also demonstrate commitment and promote improvement on our performance and on our every day professional development.
OBJECTIVE 7: Incorporate professional nursing standards and accountability into practice.
Professional nursing standards and accountability is very important to be able to provide a high quality of care. Even thought, this is not a setting were we are treating acutely ill patients, the patients in the community present psychosocial needs that require equal nursing attention and the used of the mandated nursing standards. The American Nursing Association standards are always used, since our focus in this community is to educate them on different topics, on which they need to be instructed. Research is also one of the main points in this community, since we are trying to implement the best interventions to obtain the most efficient outcomes, promoted a safety environment and a healthy population.
OBJECTIVE 8: Collaborate with clients, significant support persons and members of the healthcare team.
Collaboration with the PS 184 students, teachers, mentors and professors allowed us to identify the different psychosocial needs, neighborhood atmosphere, their family structure and psychological issue that these students are experiencing. Through the population assessment and collaboration, we were able to implement a plan where the different educational topics most required in this community were presented. In addition, not only educational elements are used during our clinical rotation, we were also able to individually mentor our assigned students. During this section we were able to listen to their concerns and provide support when required.
OBJECTIVE 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of healthcare services.
Brownsville is a community with a multiple economical, political, social and demographical issues. This is a community where unemployment has a high rate; therefore its residents are constantly financially struggling. In additions, the level of violence and drugs in this area is pretty high since there is an elevated prevalence of gangs in this neighborhood. A little political attention has been placed to attempt to promote a better community for Brownsville residents. As result, the population in this neighborhood focus mostly in the psychosocial issues that on the health issues that they may be experiencing and there is a major lack of proactive prevention. Adding to this lack of prevention, the fact that many of them are medically underserved, which is a combination that will lead to serious complication that many of them face.
