Introduction

Welcome all, this is my experience in community health nursing. It involves meeting the clients’ needs within the community. Community health is critical and is also a significant aspect of nursing. The foods, the supermarkets, the hospitals, the schools, the air, the water, the small businesses and so forth, can tell a lot about a community’s health. Assessing how clients are able to allocate well needed resources is important, as well as transportation in accessing health care. These factors are also relevant in the web of causation, as to what causes a particular illness within a community. This aspect of nursing is also very fragile and could be seen as one of the foundations of nursing. Cumberland Clinic a branch of Woodhull Hospital was the main focus. It is located in a significantly diverse community and the patients are deserving of proper care and education. It was a pleasure working with the clients in this community.

Objective1: Demonstrates individual professionalism through personal behaviors and appearance.

Client confidentiality being maintained is one of the key nursing roles. If we are advocates for our patients, we have to be advocates in protecting their information as well. Maintaining confidentially was done by not sharing or discussing patient’s information in elevators. The screens with patient’s information are closed whenever not in use, and pertinent patient information were appropriately shredded. I always try to read health brochures or health magazines or pamphlets and ask questions to enhance my learning. I completed my section of the group work on time. All necessary deadlines were adequately met. The preceptors, my clinical professor and my lecture professors were very helpful whenever needed. I would ask questions about what exactly was required of us in doing the teaching at the senior center. Help was very much provided. Clinical conferences are held usually on Wednesday mornings at Cumberland Clinic. It would be in the form of a huddle where we discussed the goals for the day and what each team member would do. I was the recorder and the time keeper. I attended clinical each morning at 8:30am and dressed in black slacks with white t-shirt/blouse according to protocol.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

At my clinical rotation at Woodhull Hospital, I would constantly ask my preceptors (staff nurses) about policies and procedures regarding patient care. I also had access to patient’s medical records and I was always present during interviews in the medicine triage area, on the floor as well as whenever there was a new OB client. I was definitely able to assess developmental, emotional, cultural, religious and spiritual influence on the client’s health status. In fact, culture played one of the biggest roles in each patient’s lives. There were a lot of beliefs about curing their illnesses, and some were very reliant on homeopathic treatments. Data in terms of pamphlets regarding client’s ailments were given at the end of each visit.  This was done as a form of reinforcement, to improve patient’s compliance and to further answer any additional questions client’s had. I was able to see my preceptors perform a physical assessment. Afterwards, they would explain step by step their assessment procedure to me and why they did particular tasks. Care was definitely prioritized. In the medicine unit, Diabetes and Hypertension was a very common diagnosis and emphasis were placed on prevention of those diseases. Furthermore, interventions were prioritized based on these prominent diseases, especially compliance and managing these illnesses.

Patients were encouraged to follow-up with their doctor within two weeks if the results were abnormal in terms of patient’s cholesterol or blood glucose reading. I have witnessed administration of medications and treatments by the staff nurses. A pre-discussion and a post discussion was usually done to enlighten me on the purpose of the medication and treatments. Proper PPE was used and safety precautions were always maintained. Whenever patients were scheduled to undergo a colonoscopy, pre and post education were usually given as supervised by staff nurse. Verbalization of understanding is also assessed afterwards as well. Client care is always evaluated by outcomes after follow-up visits.  I observed the preceptor (staff nurse) using PPE when necessary and I also demonstrated understanding.

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.

There were opportunities in which effective therapeutic communication has taken place. A lot of patients do not speak Standard English. Some spoke Creole, Spanish, Patois and other African Tribe languages.  Listening and trying to learn the basics of their languages were observed and demonstrated. Language services such as the use of an interpreter was also utilized. I communicated clearly during meetings or hubs. This took place every morning and included: staff nurses, patient care techs, nurse practitioners and doctors. I would also communicate with my instructor and the healthcare team about allocating my resources for my Service Learning project on Diabetes. A lot of times I had to speak in layman’s term to clients in order for them to gain better understanding of the situation at hand, especially when it involved managing their illness and being compliant. The preceptors were keen with documentation and I observed and demonstrated correct documentation during both my OB and Internal Medicine rotation.

Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.

The Service Learning Project about Diabetes that I will participate in will highlight Diabetes management and prevention. There will be 2 teaching sessions between my classmates and I. There will be a pre-discussion and a post discussion. Brochures or pamphlets will be used to educate the community on the chronic disease, Diabetes. The information that we will be presenting are from research that is evidenced based and the pamphlets are from the Diabetes Organization and Woodhull Hospital. It will be an open session and resident’s attendance and participation will be reinforced. As said earlier there will be a post-discussion session after each of the presentations. During regular clinical rotations, as well, clients usually verbalize understanding.

Objective 5: Utilize Informational technology when managing individual and families in the community.

The clinical sites are very equipped with computers and places a high value on technology. In fact, most of the documentations and scheduling were done on the computer via the hospital based system. The computer normally goes to sleep whenever it is not being used by the preceptor or me. However, we would close or minimize the session upon leaving the room in order to maintain patient confidentiality. The preceptors also made it a habit to identify the patient by their name and DOB. Then I would introduce myself and preceptor did the same as well, moreover, she asked if it was okay for the student nurse to be a part of the discussion.

Objective 6: Demonstrate a commitment to professional development.

Applicable and current literature review from legitimate journals were implemented to assist with planning care of the patients during clinical rotation as well as during the Service Learning Project. I believe being a Registered Nurse consists of learning new concepts and new practices throughout one’s lifetime. The health care field is ever changing and nurses are adaptable and revolutionary. I try to evaluate myself every day in terms of how I can be better than who I was yesterday. Self-evaluation every day is one of the key ingredients to growth. I must say my knowledge is increasing in this career field and most importantly, I love being a professional Registered Nurse. I value accountability and autonomy a lot in the nursing practice especially within community health nursing.  My classmates and I were very responsible in allocating resources for our community project.

Objective 7: Incorporate professional nursing standards and accountability into practice

The ANA Standards in clinical practice was most certainly utilized, care was indivuliazed in which every person responds to illness differently. Diversity of our clients were taken into consideration in order to reach a shared goal with the patients and their family members.  The hospital standards were followed throughout my rotation at Woodhull. As said above accountability is very important was upheld as well. Woodhull Hospital’s mission is to provide primary, specialty, and acute care services with emphasis on disease prevention and health promotion. Furthermore, they treat all patients regardless of their ability to pay, and they value partnership with the surrounding community in identifying and meeting health care needs.

Objective 8: Collaborate with clients, significant support persons and members of the health care team.

Collaboration with other health care members were highly valued during my clinical rotation. I get to know the different scope practices each interdisciplinary team member practices.  The most prevalent illnesses on Wednesday morning that would be highlighted were Diabetes and Hypertension. A lot of the clients seemed to be noncompliant with their medication regime and therapeutic interventions played a big role in those scenarios. A lot of the clients did not know how to diet properly, or they would choose not to diet properly. As a result, the nutritionist was offered as help on particular days. This was convenient and beneficial for the patients who were really trying to change their lifestyle. A lot of times referrals were mad to the main hospital Woodhull. The circumstances that required emergency care were directed towards the main hospital. The clinic Cumberland Clinic serviced the community on an outpatient basis.

Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.

There were a couple gaps within the health care system. The technology system used often required updates that hindered the flow of care. Also, sometimes the facility was understaffed which became inconvenient at times. Once the system is updated for nurses to document, patient care could run smoother.  The clinic being understaffed more than likely reflected the set budget in which management had to work with. Every client deserves someone to advocate for their health. I tell my patients that they should be the center of their health. Clients were directed as much as possible to resources that are meant for them. The social worker and nutritionist played a huge part in allocating hospital resources for clients.

 My community health experience is definitely one to remember. It resembles the true aspect of nursing which is meeting the community needs. A lot of times illnesses start within the community. This clinical rotation and Service Learning was a definite eye-opener. It showed the disparities within the community.  Yes, zip code do determine the level of care someone receives and their health as well. Therapeutic communication is a significant factor in many communities. The level of education needs to be assessed individually and let’s not forget culture. A lot of people have different beliefs and different practices when it comes to health care. Everyone has a different story and as health care professionals, we ought to try to meet these needs.