As a student at New York City College of Technology, in the BSN program, I have had the pleasure to take NUR 4010: Community Health Nursing. As part of the curriculum for this class, my colleagues and I participated in a service learning project, which is a teaching and learning assignment that integrates community service with academic study. The purpose of this project was to enrich learning, teach civic responsibility, and strengthen the community. As a group, we promoted learning in the community by organizing discussion sessions with clients from our assigned community sites, in which we were able to enable clients to actively participate while enhancing their comprehension of the topic at hand. The following goals and objective were required to be met:

1. Employ analytical reasoning and critical thinking strategies and when incorporating knowledge of nursing, humanities, and the biological and social sciences into the health promotion of clients families, and communities.

Throughout the course of this project, I have had to use my knowledge obtained from many disciplinary perspectives, including my background as a medical-surgical nurse, my clinical experience in a psychiatric clinical rotation, my research skills from my nursing research class, the knowledge I’ve obtained from my community health lecture, and my overall experiences dealing with the general public. I feel that the combination of skills from these areas helped me to meet the needs of the client in the community setting.

2. Employ information technologies to coordinate community care.

For the purpose of this project, it was important for my 9 colleagues and I, who were stationed at different Community Access sites, to skillfully communicate with one another. Often times this meant the use of technology in order to coordinate responsibilities, set deadlines, share research and work as a productive, cohesive group with a common goal. Additionally, at our clinical sites we were given computer access to clients’ personal files including background and medical information. We had the opportunity to edit and write progress notes in these files and handled all electronic data in a professional, confidential manner.

3. Demonstrate therapeutic communication skills when interacting with culturally diverse clients, families, and communities.

Not only is the Lower East Side a diverse neighborhood, but the residents at our clinical sites were composed of people of different ages, races, cultures, and religions, with many psychiatric medical problems, as well as  a different levels of cognitive function. In order to build a therapeutic relationship with these individuals we not only had to  communicate in a culturally competent manner, but we also had to keep in mind the attention spans, emotional issues, and mental capacities of these clients. Additionally, my colleagues and I as a whole are comprised of different cultures, ethnicities, races, ages, and backgrounds, yet we worked incredibly well together to meet our common goals.

4. Use findings from the holistic assessment of the community to diagnose, plan, implement, and evaluate the quality of healthcare.

For purposes of this clinical experience I was mindful of my own cultural beliefs, as well as the beliefs of the Community Access residents. There were certain situations in which I saw a learning opportunity for the client where I had the ability utilize my own spiritual beliefs to make a connection with the client. There were also instances in which my partner and I were able to suggest helpful holistic approaches to certain ailments in which the client may have previously not been aware of.

5. Demonstrate the collaborative role of the community health nurse in assisting the client to achieve identified goals.

Throughout the course of this clinical experience, particularly with regards to the service learning project, my partner and I encouraged clients to set obtainable goals. One resident, a heavy smoker, made a goal to reduce her smoking from one pack per day to one pack every three days. This goal was realistic and thus far she has maintained her goal and has stated the desire to cut down even further in the future. Because my clinical group is privileged enough to continue our clinical experiences at our assigned Community Access sites until May, with our next clinical class being Urban Health, we have the opportunity to continue to reassess and reevaluate these goals with the clients. We will encourage them to continue to set both long and short-term goals related to their lifestyles, health, and future.

6. Describe strategies to promote leadership skills for community health nurses.

I believe the first step in being a leader is to understand the needs of those you are going to lead.  Once a rapport has been built, understanding your followers’ needs is crucial as a community health nurse. My partner and I demonstrated leadership skills in the community by getting to know the clients and their needs, seeking out available resources, making referrals, providing information on a level that could be understood by the client, setting goals, and constantly reevaluating the clients progress.

7. Synthesize knowledge gained from nursing research in applying evidence based practice in community health nursing.

There were times over the course of the semester, particularly during the planning phase of the service learning project, when my colleagues and I questioned what would be the best way to present information to this particular clientele. Through our clinical experiences and through the use of evidence-based research, each group came up with their own unique strategies for presenting their service learning project to the Community Access residents. The use of evidence-based research assisted us in communicating in the most therapeutic way, to assure that our message was clear and concise.

8. Adhere to ethical standards, professional nursing codes, and standards of care for community-based nursing.

At our clinical sites, my partner and I followed the code of conduct and standards of Community Access, as well as the standards of the American Nurses Association and our own professional and ethical standards based on our profession as Registered Nurses. This included respecting clients right to privacy and confidentiality, as well as holding ourselves accountable for our nursing judgments and ensuring that we provided the best care, uniquely tailored to each individual and their needs.

9. Explain the importance of continuing education in nursing to enhance personal and professional development.

As Registered Nurses, we have a personal responsibility to expand on our classroom education through independent study and research. Information and techniques related to healthcare are constantly evolving and advancing and everything we do is evidence-based. It is therefore, critical for nurses to stay on top of these advancements in order to provide the best possible care to clients. Throughout the course of this clinical experience I have come across clients with diagnoses I have not dealt with in my professional experience. I made it my personal responsibility through textbooks and other forms of research to better understand these diseases in order to provide the utmost service to these clients.

10. Consider global health issues as they affect specific community health issues such as disease transmission and health policy on community-based care.

Health policy is something that I never put too much thought into before entering this Community Health Nursing class. I never understood how policies in the community came to life and how much influence we, as Registered Nurses, have on the policy process. While global health issues and policies are important to know and understand when working with a specific community, sometimes these policies have to be tailored to meet the specific needs of the community. For example, certain global policies might work for the mass population, however, these same policies could pose as barriers to a community of individuals suffering from mental illness. For the purposes of our service learning project, we identified the top three health related issues in the Lower East Side, however, these issues had to be tailored in a way to meet the needs of the specific population we deal with at Community Access.

Narrative:

In groups of two, my colleagues and I organized our discussion groups at our assigned clinical locations at several Community Access sites. Community Access, founded in 1974, offers housing, support, job training, counseling, education, and advocacy programs and aims to break the cycle of homelessness, institutionalization, and/or incarceration that often affects the lives of people dealing with mental illness.

Community Access was founded in the Lower East Side and has since expanded to other parts of New York, including Brooklyn and the Bronx. They provide housing to over 1,100 individuals with a history of psychiatric illness, homelessness and/or incarceration, and low income families. This housing includes both permanent housing in which the tenant holds their own lease and transitional housing, which usually consists of a 6 to 18 month stay and helps people move from shelters and hospitals into the community. Individuals at both types of housing receive services from highly-trained on-site service coordinators, counseling services, crisis intervention, goal planning, and referrals to outside resources and services.

My clinical group consists of 10 individuals, divided in groups of 2 at different Community Access sites in the vicinity of the Lower East Side. For purposing of our service learning project, it was important for us to become familiar with this neighborhood and understand its strengths and weaknesses. We gathered information about the Lower East Side through both our own individual exploration of the area and data collected from the New York City Department of Health and Mental Hygiene, the New York City Department of Planning, and other data sources.

We researched the main issues related to health in this community and found, through the Department of Mental Health and Hygiene, the top three to be cigarette smoking, heart health, and obtaining regular doctor visits/keeping appointments. All three of these health issues not only correlated to the population of the community as a whole, but also to the population we were working with at our Community Access sites. Many of these residents are cigarette smokers, with heart related health problems, like hypertension, and also struggle with seeking healthcare and finding a primary care provider. Keeping in mind the mental health issues of the clientele, we chose to carry out discussion groups, as opposed to a formal presentation because we felt it would better promote participation and understanding of the topics.

My partner, Garielcie, and I were assigned to two locations in which we transitioned from    one location to the next halfway through our clinical day. The first location is Libby House, located at 347 East 4^th Street and the second, Access House, located just a few short blocks away at 220 East 7^th Street. Both of these locations are transitional residences, in which many of the tenants were previously institutionalized and are currently acculturating back into the community.

As a group, we came up with the following goals related to the three discussion topics. With all of these goals in mind, my partner and I conducted a successful discussion group and tried our best to meet each goal.

A) Smoking cessation: Clients will identify their smoking patterns and trigger, identify 3 physical effects of smoking, identify alternative measures to smoking, and set a personal goal related to reducing the amount of cigarettes smoked per day.

B) Heart health: Clients will have a brief understanding of the meaning of heart health and hypertension, understand that smoking affects the heart, identify their personal risk factors for poor heart health, identify foods that are heart healthy, and set a personal goal towards improving their heart health.

C) Regular doctor visits/keeping appointments: Clients will express reasons why they may avoid going to the doctor, identify the importance of taking medications as prescribed, understand the importance of discussing medication side effects with their PCP, understand how regular checkups can prevent future health issues and decrease hospitalizations, and clients will be directed to a PCP if they currently do not have one.

Throughout the course of my clinical experience at Community Access, along with my in-class learning and independent studies, I feel that I have fulfilled each of the student learning outcomes and general education learning goals. As the semester comes to a close, and looking back on each goal/objective and how each was met, I feel enriched in having successfully navigated through this journey. While I feel that the service learning project was a success, I also feel that the overall day-to-day interactions with residents at Community Access were equally as successful. We have had the opportunity to build trusting, therapeutic relationships with people suffering from a variety of psychiatric illnesses and who, not long ago, may have been hospitalized, institutionalized, incarcerated, or homeless. It has been a pleasure to not only be a part of a new community, but to be a part of people’s lives as they make their transition back into the community.