Introduction
This narrative self-reflection is a clinical evaluation tool which is used to review my personal experience of the clinical rotations for community health nursing at Cypress Hills Child Corporation Head Start Family Day Care, which is located at 3295 Fulton Street, Brooklyn NY 11208. I had the privilege of interacting with small children and teaching them basic healthy practices to help them develop habits at an early age to prevent the spread of infection and maintain a healthy physical state. There were a total of 16 children in each class. Our goal was to reach 10 children per presentation per week and have at least a 50% participation rate by the children.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
During my clinical rotations at Cypress Hills Headstart Center, We reviewed medical records, maintained client confidentiality by obtaining permission before beginning our teaching sessions and reviewing the clients’ medical records. As a nurse, I believe that I am responsible for my own learning because teaching is part of my duty. I have learned information through interacting with the staff, and researching our education topics, which included infection control, influenza, exercise, dental hygiene, allergies, and nutrition. To prepare for clinical learning, the course textbook was utilized, along with reviewing material for the community nursing lecture. Our assignments were as follows: The clinical rotation students were separated into 2 groups. Each group presented every other week, and for the week of April 17th 2018. Both groups presented collectively to the parents of the children. All presentation assignments were successfully completed in the designated time frame. Throughout semester, a professional social network of group texting and electronic mailing was utilized as necessary to communicate with other students and the clinical instructor for guidance when needed. I participated in the weekly clinical conferences, which were held to plan and discuss future educational sessions for the children, the overview of the community, and the most effective way of reaching it. I attended the clinical punctually and in accordance with school policy, while maintaining a professional dress code.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
To better assess the children at the clinical site, and the community as well, we assisted the clinical site coordinator with reviewing the medical records of the clients to ensure that they were up to date. We’ve achieved our goal of reviewing the physical assessments of 30 clients throughout the semester. From the assessments, we noticed that one-third of the children did not have their influenza vaccine, many had a BMI outside of the normal range, and many had food allergies. Combining this information with the community health assessment from the windshield survey, we were able to come up with our topics to teach the children at Cypress Hills Headstart Center. Our nursing intervention was to teach the clients. In planning this intervention we prioritized the topics of influenza/ infection control, nutrition, and food allergies. The teaching sessions were held on a weekly basis, with a goal of reaching 25 children per week. Although no medications were administered, our presentation included the discussion of safe administering of epi pens, its uses, benefits, and the influenza vaccine. The outcome of the intervention was evaluated with pretests before each presentation, and posttests at the end of every presentation, where the children verbalized or demonstrated their understanding. In reflection of our practice, we modified our presentations after the first two weeks to appeal to our 2 different client populations of 4-5 year olds, and 3-4 year olds. Based on the posttest from the first 2 presentations on the younger population, we learned that using the same style of teaching was less effective for them due to their shorter attention span. A safe environment was maintained at all times. Hand washing was enforced and utilized when necessary, and supplies were kept out of reach when not in-use.
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.
When giving the presentations, therapeutic communication was utilized. We physically adjusted ourselves to the level of the children by sitting on the carpet or on one of their small classroom chairs. The channel of communication utilized with our clients, was face-to-face communication. To aid in our the effectiveness of our presentations, we used laptop computers for videos and PowerPoint slideshows, a poster display for myplate, and display models such as artificial fruits and vegetables. When we were not with our clients, we communicated with the instructor, peers, and other professional personnel at the clinical site through e-mails, group texting, and/or face-to-face conversations. Data communicated to the instructor and healthcare team included in-depth discussion of the topics for teaching, scheduling of dates and times for presentations, and collaboration with the classroom instructors to give the most effective presentations possible. The 2 client populations were 3-4 year olds, and 4-5 year olds. We utilized appropriate communication techniques such as using simple words, speaking in short sentences, speaking clearly, encouraging hand-raising, setting boundaries, and limiting the presentation to 15 minutes. All tasks performed, including nursing interventions, were documented on a log, which is collected by the clinical instructor at the end of the term.
Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence-based practice.
During the course of presenting to the children, we wanted to find a way to reach the community even further. Although informing the children of healthy habits at a young age is important, there are many factors that are out of their control. With this notion, we decided to implement a teaching plan for adults (which included the parents of the children). The topics of focus were influenza and allergies, since they can both be life-threatening. The plan was implemented on April 17th, 2018. To establish an environment conducive to learning, the presentation was held in a conference room with a large table and projection screen. Due to the demographics of the community, we created 2 PowerPoint presentations, which each were presented in both English and Spanish. The purpose was to eradicate any language barriers that may arise. To our surprise, the adults that showed up were more responsive to the presentation when it was translated to Spanish, as English was not their first language. The learning outcomes of the adults were evaluated by a series of true or false questions during the presentation. Eight out of 10 of the questions were answered correctly, and the correct and incorrect answers were explained in detail. We also received positive feedback from each individual adult as well. We’ve achieved our goal of reaching at least 3 adults.
Objective 5: Utilize informational technology when managing individual and families in the community.
During clinical, the principals of nursing informatics were utilized through compiling information from multiple database resources to allow us utilize the nursing process as effectively as possible. This information included the most up-to-date community health profile for Brooklyn Community District 5 (which includes Cypress Hills) from the NYC department of Health website and physical medical records of our clients. We also conducted a windshield survey of the community. With this wealth of information from our assessments of the community and our clients, we were able to come up with the following a nursing diagnosis for them, establish a plan of action, implement the plan of action, and evaluate the effectiveness. Strict confidentiality was maintained when handling client records. Reviewing was done in an area separate from the rest of the facility and the records required the signature of all who viewed them. Each of us were given a record to review, filled out a form based on the completeness of the record, and signed it.
Objective 6: Demonstrate a commitment to professional development.
In planning care for clients, literature was used from textbooks, the Centers for Disease Control and Prevention website, and videos from YouTube. Educational resources tailored to children were sought after, in order to more effectively reach the clients and attain at least 50% participation. Although the research and treatment experience from this course allowed me to extend my knowledge as a health care professional, I believe that it is my responsibility to seek out lifelong learning during the course of my practice. I engage in self-evaluation by observing the outcome of my care, gaining feedback from those that I treated, and using that information to make improvements for the next time that I give care. I also learned that there are many challenges of practicing independently in a community health setting. I showed adjustment to the challenges of practicing in a community health setting, by inquiring about professional organizations for nurses through my clinical instructor, and by staying informed about any changes in the community (or public policy) that would affect the healthcare of the clients. For example, the changes of influenza were researched and included in one of our presentations.
Objective 7: Incorporate professional nursing standards and accountability into practice.
For my clinical experience this semester, the American Nurses Association Standards were utilized. Registered nurses offered health promotion through teaching, to optimize health and prevent illness of the children at Cypress Hills Head Start Family Day Care. These illnesses were respiratory infections, allergic reactions, and oral infections/dental carries. Education for optimization of health included eating a well-balanced meal, exercise, basic infection control measures, obtaining the influenza vaccine, and maintaining adequate oral hygiene. The series of presentations took place between February 27th , 2018, and April 17th 2018, for a total of 6 presentations. Five of the presentations were for children, one was for adults. We complied with the agency’s standards of practice, which was to ensure a safe learning environment for the children, while maintaining their privacy. The classroom instructors of the children were present for every presentation. I was accountable for all of my actions in the clinical area, including reviewing the medical records, the activities demonstrated during the presentations, such as handwashing, and returning borrowed items from the classroom for demonstration purposes. As stated on their website, the mission of Cypress Hills Child Care Cooperation is “to strengthen families in our community by increasing the availability of quality, affordable child care for low-income families and creating entrepreneurship opportunities for low-income women.”
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
As professional nurses, we collaborated with each other, with the instructor (who is a nurse practitioner), and with the coordinator of the site to address client problems. Since the coordinator of the site is familiar with the children, he was a good resource for information on what health issues among the children at the site should receive the most attention. Although we did not directly contact any of the children’s’ physicians, we did review the documents of assessments, tests, and evaluations done by them. Some children had health issues such as impaired hearing or vision, food and environmental allergies, asthma, dental carries, and obesity. Reviewing these issues among each other, we created care plans based on the general needs of the children in all 4 classrooms at the site. Since there were 16 children in each classroom, we figured that we would not realistically be able to give an individualized presentation for each of them. However, we were willing to make adjustments to our presentations if any children had difficulty. Health care resources were discussed with the parents during the adult presentation on the We informed them of specific areas of NYC.gov and CDC.gov, where they can print material (in multiple languages) for a variety of health issues. To guide the children to make appropriate lifestyle changes, I demonstrated the correct way to wash your hands at a real sink inside the classroom. I then had 5 children perform return demonstration. For nutrition, I demonstrated how to choose foods to create a well-balanced meal. Using artificial foods from the classrooms, such as fruits, vegetables, water, chicken, pizza, milk, eggs, cheese, etc. I layed out the foods across a table and called on children to show how they would prepare their own plate for breakfast. Through this, I learned that most of the children did not know what a healthy meal consisted of. Some chose only junk food. I explained the different types of food groups, why we needed them, and showed the right way to create a plate, using the myplate chart. At the end, a post test was given, and most of the children understood how to create a well-balanced meal. Although we did not directly assist clients to make connections to other community agencies, we encouraged the parents to ask their doctor about services in the community which they could get help from, but may not be familiar with.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
This clinical experience showed me that there are some gaps in the health care system. They include lack of access to services in underprivileged communities, lack of health insurance among many people, providers not spending enough time with clients, and lack of education of clients on preventive care and how to maintain good health. A solution to the issue of malnutrition at the clinical site would be to educate the parents on their choices of foods, what they feed the children, and portion sizes. Being familiar with the traditional foods consumed on a regular basis will help reach and guide the parents in the right direction to feed their children a well-balanced diet. This can be accomplished through a community health nurse having a 30 minute presentation (in English and Spanish) for parents at the end of each school day for one week (Monday-Friday) at the day care center. Every day the same material will be presented. This will give the parents an opportunity to see the presentation when they come to pick up their children. Holding the presentation for 5 days will allow for as many parents as possible to have access. If the parent is unable to see the presentation on one day of the week, perhaps they can see it on another day.
Conclusion:
We successfully reached all of our goals for this clinical. We reached 15 children per week instead of 10, and got 90% participation instead of 50%. Post tests were used as evaluation tools at the end of each presentation, which was proven to be successful. Feedback for the staff at the clinical site was also positive.
