Nicole Smith
Self Reflection Narrative
NUR: 4110
Dr. Aida Egues
June 24,2015
Introduction
Before I took this class, I thought community nursing was particularly home care nursing. I did not know community nursing consists of so many different areas of caregiving. It is very in depth; this aspect of care is not so simple as it seems; it entails much work. As with any area of nursing, I think a community nurse must be focused, patient and strong with a sense of determination because not all the required resources are always available in the community. Some clients are not compliant, and the family support is absent. At times, as nurses, we wish we could solve all problems but unfortunately, there are times when we have to work with what we have at hand and hope for the best. As community nurses, we have encountered clients that are of different cultures and speak different languages. In my duties at the clinical sites at Lady Church Of Refuge, a food pantry, and Salvation Army, a soup kitchen, which are affiliated with Lutheran Hospital, I have seen the importance of having nurses who are culturally aware and are fluent in more than one language, especially Spanish, Creole, and Mandarin; those are the languages that are spoken at the clinical sites.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
Throughout my clinical rotations, I prepare for my clinical learning from the previous night by making sure that I have all necessary supplies which include my stethoscope, how to calculate BMI, my notepad, and pen. I dress professionally and wear my ID where it is visible and can be seen at all times, and I wear my lab coat worn in accordance with the school policy. I arrive at the clinical sites on time in accordance with the school policy. On each clinical day, we have a pre and post conference in which I actively participate, and we discuss with our clinical professor what our focus is going to be on for the day. I have made sure to maintain confidentiality according to the standards set by HIPPA. I secure my clients’ personal and medical information out of the reach of other clients. When I am gathering information for surveys, I maintain a low tone of voice so that the conversation can only be heard by the client and myself. I take initiative; if my area of service is slow during any day, I help my colleagues if I see them struggling. I prepare for clinical learning by utilizing the Internet, nursing journals, my community textbook, my colleagues, and my clinical and lecture professors. My assignments are completed within the designated timeframe. If there is a problem or something that I do not understand at my assigned clinical site, I seek clarification from my clinical professor.
Objective 2: Employ analytical reasoning and critical thinking when providing care to individuals and families in the community setting.
Interviews were used to collect information from the clients. We worked along with other members of the health care team to collect information; Sister Fran who organized the sites, was the go-to person if we needed clarification with any paper work regarding blood pressure, BMI, and surveys. RN Susan and Sandy, a volunteer, have the responsibilities for taking Blood Pressure and educating the clients in accordance with the results, and we also had a worker from Lutheran who helped clients to apply for health insurance; she was on site the first Wednesday of every month. Clients were very religious and were mainly from the Catholic faith, which was their coping mechanism of dealing with any health issue or illness they may have; both clinical sites were of the Catholic faith, and often, before the clients enter the church, they would make a sign the cross or pray briefly. Most of the clients were in compliance with activities of daily living in order to meet their self-care needs. Clients were seen for their blood pressure and BMI screenings as well as gathering information via surveys. Care was based on first come first served, and for clients who were willing to participate in the screenings. Safety was maintained during our blood pressure screening; clients were given chairs on which to sit, and their arms were rested comfortably on a table. Medications and treatments were not administered for our clinical rotation, clients were taught about proper diet, normal readings for blood pressure, and the adverse effects of high blood pressure. We were able to monitor the clients’ blood pressure results by giving them a booklet with the results; they would bring it each time they came to have their blood pressure monitored, and we were able to implement the nursing process.
Objective 3: Effectively communicate with the diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting.
Space was given when communicating with the clients, direct eye contact was maintained, colleagues were utilized for translation. Majority of our clients spoke Creole and Spanish. We communicated with instructor, colleagues as well as healthcare team clearly and effectively by means of blackboard and pre and post conference. Communication skills were adopted according to the developmental needs of the clients, keeping the presentations short (5-10 minutes) using simple words during presentations and respecting the client’s personal space. Nursing interventions were done accurately by educating the clients about the importance of taking medications and calling the ambulance when there is an extremely high blood pressure reading.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence based practice.
Presentations are done weekly for our clients in areas that affect them the most. These include blood pressure readings and BMI screenings, explaining the readings that are normal and the readings that should prompt the clients to go to the emergency room; clients are also educated about obesity and nutrition. Teachings are done immediately before clients get their meals for the day. Clients are encouraged to ask questions. Teaching materials were used to accommodate the different languages, flyers were in Spanish to help the clients understand the information that was being presented. Translation was done in Spanish. The library at City Technical College was utilized to obtain important information.
Objective 5: Utilize informational technology when managing individuals and families in the community.
I was able to obtain evidence based health information, using information technology to care for my clients, which was convenient because this process enabled clients to obtain the information immediately. Strict confidentiality was maintained when conducting surveys; blood pressure, BMI readings and other personal information regarding the client’s health. Information was for the sole use of Lutheran Hospital; nurses were not allowed to take anything with the client’s information.
Objective 6: Demonstrate a commitment to professional development.
I assume responsibility for life-long learning by continuing education, subscribing to nursing magazine, be certified in my areas of practice and attend nursing seminars. Nursing journals and flyers from the Department of Health were used in planning care for clients in the community; some clients verbalized understanding of learning by asking questions and stating their understanding of what was taught. I engaged in self-evaluation by discussing with colleagues and professor all that I did and learned in post conference; I completed my weekly blog that enabled me to share my clinical experience with my lecturer-professor and colleagues. I am committed to adjusting to the challenges of working independently in community nursing by being open to clients’ cultures and adjusting to changes that will provide the best possible care for clients.
Objective 7: Incorporate professional nursing standards and accountability into practice.
I maintained the nursing scope of practice that is set by the American Nurses Standard in the clinical area by providing safe quality care and preserving privacy and confidentiality. I comply with Agency Standards of practice by performing the blood pressure, BMI readings, gathering surveys, educating and teaching the clients. I respect and support the Mission Statement of Lutheran Hospital in providing quality health care services to culturally diverse populations regardless of their financial status.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
Collaborate with members of the healthcare team to address clients‘ problems and refer clients to the appropriate health care members; clients are encouraged to keep their scheduled appointments, take their medications on time, and they are taught breathing exercises to relieve stress. Local clinical and senior day care services that are in the community have been recommended for clients. Clients are educated on making healthy choices and lifestyle changes; they are taught how to read nutrition labels, how to calculate their BMI and be aware of its meaning, as well as incorporate exercise by taking walks together as families, thereby utilizing their local parks.
Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
The economic, political, social, and demographic forces have an impact on the availability of healthcare services in the community. There are gaps in our healthcare system that influence the delivery of care to the clients. Majority of our clients are of low socioeconomic status; they have limited or no access to healthcare; they are immigrants, and they have language barriers. Because of these limitations, there are rates of high blood pressure, obesity, and heart disease. We can rectify these limitations; in order to do so, healthcare should be available to all; no matter their socioeconomic status or immigration status, healthcare facilities should be made accessible to all and within good travelling distance; there should be the possibility to offer more services at various food pantries and soup kitchens. In addition, if the clients, due to any reason, cannot attend the site for their screenings, there should be means of getting the services to them. In addition, thought must be given to utilizing public areas for healthcare services. It is in this context that the parks, libraries, churches and other areas could be used to provide health care services. We, as stakeholders, can start conversing with the local politicians and clergy, investors and clients to let them know of the need for more healthcare services based on the increased amount of high blood pressure, obesity and heart disease in the community, and this could involve support professional organizations that advocate and encourage policies and practices that promote health care.
Conclusion
In conclusion, I have learned much about community health nurses, and I have discovered that they are in the forefront of the efforts to combat and treat diseases by giving care to clients and their families from various religious organizations and socioeconomic status in the community. My clinical experience of working in the community has taught me that Community Nurses get to know the families of the clients to whom they give nursing care, and this helps in getting more compliance from clients and their loved ones, as a trusting and lifelong relationship will exist in a professional manner. At times, it is frustrating to see the health disparities that are encountered by the members of the community; compared with other communities, there is a vast lack of services present; however, it is rewarding to see ourselves making a difference in the lives of our clients by educating and treating, as well as referring them to the appropriate multidisciplinary teams for the care and attention that they need.
