E-portfolio @ VNSNY

E-PORTFOLIO REFLECTION

I was assigned to a nursing organization in Brooklyn for my clinical rotation. Initially I was paired with a nurse from the agency for about 2-3 weeks. I went into client’s homes and observed as the nurse performed her duties. After the termination of this period I was paired up with another student nurse until the termination of the semester. It was a very challenging and rewarding experience. Student nurses were not allowed to administer medications as per agency policy, but we were allowed to perform dressing changes on clients. Throughout this experience I remained as professional as possible when interacting with clients and their families, and I appreciate the opportunity of being able to serve the community in the competent care that I provided, to these individuals.

OBJECTIVE 1:DEMONSTRATES INDIVIDUAL PROFESSIONALISM THROUGH PERSONAL BEHAVIORS AND APPEARANCE.

Client confidentiality was maintained in the strictest sense as client’s financial records/insurance information were not viewed on “tablets”(which are small computers utilized by the organization’s nurses). Personal health information and (Health Insurance Portability and Accountability Act) HIPPA regulations were in effect. I assumed responsibility for personal learning, because BLOGS were posted once a month to demonstrate what was learned in the “field”.I was always on time for my clinical experience by arriving promptly at 8:30am. All my assignments were completed within the designated time frame-their was no tardy assignments. I sought guidance appropriately at all times, before entering into the field, instructions from the professor about conduct in the field was heeded. I participated actively in clinical conferences since students must complete all documentation on patient visits during clinical post conference. I always maintained the professional attire of dark slacks/bottoms and white tops in effect as per day one.

OBJECTIVE 2: EMPLOY ANALYTICAL REASONING AND CRITICAL THINKING WHEN PROVIDING CARE TO INDIVIDUALS AND FAMILIES IN THE COMMUNITY SETTING.

Client information in its entirety is extremely significant in having all information to provide the best and most efficient care. As I entered the field I paid significant attention to the client’s emotional, cultural, religious, and spiritual characteristics noting that if positive it can do much in producing better health outcomes. I collected significant data relevant to client’s self care needs by noting if bathing, toileting, dressing etcetera was being performed regularly and efficiently. A complete physical assessment of particular clients was not possible to perform. I prioritized care based on my analysis of data by noting clients with complex physical ailments such as multiple decubuti and noting that these issues be given priority initially during a home visit. During each visit to client’s homes care was provided/prioritized in order of importance and each visit typically lasted from 30 to 40 minutes. I was not allowed to administer medications in the field but treatment such as wound dressing changes was performed. After the termination of each visit to the client’s homes a nurses’ note was document on the “tablet” as part of the client’s permanent record. This note was evaluated by the nursing supervisor as indicative of the quality of care that was provided to the clients. The organization’s policy stipulates that nurses should refuse to enter into homes that they deem unsafe, such as the presence of large threatening pets.

 

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.

I employed the use of therapeutic communication skills by actively listening to the concerns of clients and their families. On one occasion it was necessary to use a translator in order to effectively communicate with a client. On the field clear succinct communication is vital so that no errors are made in planning client care visits. When communicating with clients I made a point of not using high flown language and medical jargon as this would have been inappropriate when communicating with clients whose educational background was unknown. The ‘tablets’ that I used when in the field was equipped with detailed questions so that assessment were completed with detailed accuracy.

OBJECTIVE 4: ESTABLISH ENVIRONMENT CONDUCIVE TO LEARNING AND USE A PLAN FOR LEARNERS BASED ON EVIDENCE-BASED PRACTICE.

When in the field I stressed the importance of strict adherence to prescribed medication regiments to clients and their families.  In some cases family members are responsible for administering medications to clients. Clients were taught important information about their health status in the comfort of the homes in an effort to establish an environment conducive to learning. Clients were also allowed the freedom to ask the nurse any questions concerning their health status in an effort to evaluate client/family learning outcomes.

OBJECTIVE5: UTILIZE INFORMATIONAL TECHNOLOGY WHEN MANAGING INDIVIDUAL AND FAMILIES IN THE COMMUNITY.

To utilize principles of nursing informatics in the clinical area I as a nurse had the ability to do computer “searches” on client’s current medication regimen.  And in an effort to maintain strict confidentiality with client records these records that had identifying information were discarded after it was utilized.

 

 

OBJECTIVE 6: DEMONSTRATE A COMMITMENT TO PROFESSIONAL DEVELOPMENT

In using appropriate current literature in planning care for clients in the community setting I as a nurse utilized avenues such as the Internet and medical databases in appropriating current literature in  planning care for clients. To assume responsibility for lifelong learning I in addition to all nursing professionals can continue their educational status by pursuing masters and doctoral degrees.  In engaging in self-evaluation nurses such as myself can critique ourselves at the end of every work day or week to improve on areas of weakness. Personally I as a nurse can learn as much as I can from other experienced nurses, as a means of adjusting to the challenges of independent practice in community health nursing.

OBJECTIVE 7: INCORPORATE PROFESSIONAL NURSING STANDARDS AND ACCOUNTABILTITY INTO PRACTICE

As a nurse I incorporate the American Nurses Association Standards in clinical practice. ANA diagnoses are utilized in documenting client’s nursing notes. Agency standards of practice mandates that  nurses be on time for their appointments and provide clients with a 2 hour “window” for arrival to their homes. I am accountable for actions in the clinical area such that medication or other errors needs to be reported to the agency as soon as possible after it occurs. I am aware of the assigned agency’s mission of the VNSNY which is to provide the highest quality of care to clients in the comfort and security of their homes.

OBJECTIVE 8:COLLOBORATE WITH CLIENTS, SIGNIFICANT SUPPORT PERSONS AND MEMBERS OF THE HEALTH CARE TEAM

In an effort to collaborate effectively with the health care team to address client problems, two nurses from the clinical setting receive assignments and instructions for client interventions via the supervisors. To coordinate client-care based on client needs and therapeutic interventions, client’s needs are made the main concern during every visit. Clients and their families are free to contact the organization for any questions or problems that is a cause for concern, in an effort to identify health care resources for clients and their families.  In an effort to guide clients/families to make appropriate lifestyle and treatment choices, clients and their families are encouraged to terminate unhealthy health practices that may further compromise the health of the client. I as a nurse can assist clients to make connections to other community agencies by referring them to community services such as the Meals On Wheels program, etcetera.

OBJECTIVE 9:RECOGNIZE THE IMPACT OF ECONOMIC, POLITICAL, SOCIAL AND DEMOGRAPHIC FORCES THAT AFFECT THE DELIVERY OF HEALTH CARE SERVICES.

As a nurse it is my duty to recognize gaps in the delivery of care, such as the fact that clients may not be able to be put in touch with a medical doctor as soon as it becomes necessary. In an effort to identify solutions to complex problems in the clinical area, it may be necessary to note that client’s insurance coverage may not cover home health aide services, etcetera. I as a nurse can act as a change agent in advocating to appropriate health care resources for client/families by advocating for the inclusion of para health professional services within client’s homes.

Community health nursing is both demanding and highly rewarding.  These nurses are afforded a certain degree of autonomy that nurses in other clinical settings are not afforded. I am sincerely grateful for the weeks that I was able to enter into client’s homes to provide care. I anticipate that in some period of my professional career I would enter into and serve the community as a nurse offering the best professional competent care possible.