Narrative Self Reflection
Naftaly Henriquez Polanco RN, AAS
New York City College of Technology
Community Health Nursing
NUR 4010
Dr. Aida Egues, DNP, RN, APHN-BC, PHCNS-BC,CNE
May 16th , 2016

Objective one encompasses the demonstration of individual professionalism through personal behaviors and appearance. I was able to achieve this by maintaining client confidentiality in accordance to HIPPA and confidentiality laws. This enable me to build a therapeutic relationship with my clients at Masaryk towers. I assumed the responsibility for own learning by researching about the particular needs of the community at Masaryk towers. Reading health reports and community board needs gave me more insight of what needs to be accomplished at the LES. I prepared for clinical learning by completing the assignments within designated time frame. Also by staying current with the healthcare news and updates in the delivery of care. Due to the different setting at Masaryk it not being a typical community clinical site. I sought guidance during appropriate times to understand how to address certain complex situations happened. I showed that I was engaged in this clinical experience by participating actively in clinical conferences in both pre and post conference. Attending clinical punctually and in accordance with school policy was vital in order to attend the conferences and lay out the plan for the day. Dressing professionally and wearing my lab coat is vital to building rapport with the residents at Masaryk. It also enables us to dignify our profession and it makes you work comfortably because you feel good.
Objective two involved employing analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. At Masaryk the use of critical thinking is vital as care takes place in a non-formal environment. Our interactions mainly took place at the lobby of building. I used client interviewing as basic unit for our interactions. Masaryk is under the Cooperator’s advocacy program (CAP). There’s no formal nursing and medical records. We had a preceptor Ms. Caroline English a retired registered nurse and sometimes we had Ms. Amy the staff nurse. We interacted with the United Jewish Council when providing social services as a mean to communicate with other health professionals.
Culture plays an important role in the delivery of care. I was able to assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status. When performing these interviews having these in mind is vital also when planning interventions. When performing home I was able to collect significant data relevant to client’s self-care needs, past medical history and medical problems. In making these home visits with my partner I was able to determine that certain clients weren’t able to perform their ADL’s. During these visits I was able complete a physical assessment of selected clients that CAP had assigned us to perform on the selected dates. These assessments allowed us as partners to prioritize care based on analysis of data that was collected. Applying priority-setting in planning nursing interventions. I was able to accomplish this when consulting with my partner, professor and preceptor. This consulting yielded the list of priorities of that had to be addressed immediately.
Our care was implemented safely, we sought to deliver appropriate nursing interventions in a timely manner for the appropriate circumstances. Administering medications and treatments safely. I was not able to accomplish this it does not apply to Masaryk, we only provided teaching regarding their prescriptions. We were able to do teaching about medications in our lobby stations and when performing home visits. We evaluate the outcomes of nursing care by continuing to follow up with our clients for 14 weeks. I was able to reflect about my practice. Modify client care as indicated by evaluation of client outcomes. Utilizes principles of personal safety when working in the community setting. I was able to accomplish this objective by making sure I was being accompanied by partner when making home visits. Working in pairs allowed us to be safe and performed a more thorough assessment.
Objective three addresses my ability to 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 was able to utilize therapeutic communication skills with individuals and families in the community setting of Masaryk towers. Utilizing the appropriate channels of communication involves using both verbal and nonverbal communication. Communicates clearly and effectively with instructor, peers and the health care team. Communicates significant data to instructor and the healthcare team I was able to do this when performing assessments and some issues came up that needed to be addressed. Adapting my communication skills to the developmental needs of the client. Due to the high elderly population we need to simplify our terms and ensure that our clients understand our teaching. Reporting and documenting assessments and nursing interventions accurately is important in any setting.
Objective four involves establishing environment conducive to learning and use a plan for learners based on evidence-based practice. We were able to develop and implement a teaching plan for an adult and/ or family in the community setting. We were able to conduct a nutritional teaching workshop at our lobby. We were able establish environment conducive to learning. We had a table set up in the lobby were able to perform teaching sessions and provide screening. Evaluating client/family learning outcomes was something that we accomplished through return demonstration. During the health fair we able to measure the effectiveness of our teaching by using pre and posttest.
Objective five encompasses utilize informational technology when managing individual and families in the community. Due to the informality of the setting of CAP/Masaryk using technology was no available we had to resort to paper documentation and using written materials to teach. Utilize principles of nursing informatics in the clinical area this is not applicable to Masaryk. Maintaining strict confidentiality with client records which were referrals for follow up. This was achieved by making sure all the information was kept inside folders and stored in a locked office.
Objective six is to demonstrate a commitment to professional development. Uses appropriate current literature in planning care for clients in the community setting. Resorting to websites such as the American Heart Association, the CDC, and NYC.gov. We were able to tailor a teaching plan that was current and fits the needs at Masaryk. I had to be accountable and assume responsibility for lifelong learning by keeping up with the new literature. Our profession is constantly changing, our interventions are evidenced based thus creating a need to always research. During our stay at Masaryk the Zika virus became a public health crisis. It was important to research and keep with the latest research regarding Zika. The reason being is that Masaryk is located near a large body of water the East River. This environment is conducive to having lots of mosquitos and also a lot of the residents travel abroad during the summer. Engaging in self-evaluation is a practice that aided me to reflect and perceive the areas that I was lacking in. For instance performing manual blood pressures at the beginning of the semester was something that I had not done in a while. Knowing this I bought a cuff and practiced at home until I felt comfortable. I am committed to adjusting to the challenges of independent practice in community health nursing. By understanding that a lot of responsibility is on my shoulders. Therefore I have to be a competent practitioner that is able to assess, evaluate and take immediate action if needed.
Objective seven sought to incorporate professional nursing standards and accountability into our practice. I was able to achieve this by utilizing American Nurses Association Standards in clinical practice. These principles govern our practice and dictate the scope of our practice, therefore as a professional registered nurse I had to make sure I was doing so. Another important thing to comply with agency standards of practice. CAP/Masaryk was a unique environment by not being so structured as a health care facilities but it had it policies and procedures that we oriented on. As a professional registered nurse I have to be accountable for actions in the clinical area. Performing my intervention within my scope of practice, enforcing infection control policies and universal precautions when doing blood glucose readings. I had to be aware of my assigned agency‘s mission. CAP seeks to advocate for those in need that have no help otherwise, by providing free screening, follow ups and aiding the residents to seek social services.
Objective eight involves collaborating with clients, significant support persons and members of the health care team. This was achieved during this experience during our lobby session and our health fair event. Collaborating effectively with health care team to address client problems is an important part of interdisciplinary work that we performed at Masaryk. The service learning project aided us in coordinating client-care based on client needs and therapeutic interventions. We sought have to have a health fair addressing the impeding need to be prepared in the event of a disaster. Teaching them how to prepare these people with comorbidities to survive a catastrophic event. This project enabled me to identify the local health care resources that are available for client/families in the LES. Guiding clients/families through teaching at the individual lobbies and the health fair. This enabled them to make appropriate lifestyle changes and treatment choices. We constantly assisting the clients to make connections to other community agencies by providing assistance to contact the agency proving social services
Objective nine entailed recognizing the impact of economic, political, social and demographic forces that affect the delivery of health care services. When working in the service learning project I was able to comprehend how these factors affect Masaryk and the LES. The first step is to recognize gaps in care system, not every community has the access to healthcare. The community at Masaryk is fortunate to have Betances Medical Center on Henry Street. This health center has been part of the community since 1970. Masaryk has multiple pharmacies within the vicinity of the complex. I began to identify solutions to complex problems in the clinical area, this community needs more resource allocation. Grand Street community center could be closed very soon, leaving many seniors without a nearby center to recreate.
This community needs more teaching regarding the safe use of medications, appropriate disposal, diet, nutrition and management of chronic comorbidities (diabetes and hypertension.) As a registered nurse I have to acts as change agent in advocating to appropriate health care resources for client/families. Encouraging clients to go and see their primary care providers, nutritional teaching, and blood pressure/ blood glucose readings. We were able to connect many residents to social workers at the United Jewish Council to help with rent regulation.