Category: Coursework

The Baccalaureate program at City Tech has taught me many things. This program taught me what it truly is to be a professional nurse. I took the following courses: Physical Assessment, Nursing Research, Leadership, Community Health, Case Management, Nursing Communication, Urban Health, and Professional Nursing. These courses helped me to build on the skills I’ve acquired during the associate’s program.  These eight courses have taught me that nursing extends far beyond the bedside. There are so many avenues in the field of nursing. In the courses Community Health, Urban Health and Professional Nursing, I was able to give back to the community. I engaged in teaching patients about women’s health in Kings County. In Urban Health, I got the opportunity to participate with the clinical group in a proposal project for a Boys and Girls club in Brownsville to help kids with obesity and asthma. In Professional Nursing, I took part in a professional advocacy activity, the March for Babies. My communication skills and writing skills have gotten better. It felt amazing to be able to implement the knowledge I have obtained during the baccalaureate program to help individuals within the community to make better health decisions. I will continue to educate myself to help others and never limit myself.

Throughout my years at City Tech, I gained sufficient knowledge about the nursing profession. One strength is communication. Communication is important when dealing with patients as well as coworkers. When I first started as a nursing student in the associate’s program, I was nervous to speak with the patients. After a while, I was no longer nervous and communicated with my patients effectively. As a nurse, communicating is always necessary.   Asking for assistance when needed is another strength of mine. If i am unsure of something, I would ask someone who is more knowledgeable than I am. Asking questions can help prevent errors and maintain patient safety.  I am also open to new ideas. This is vital because the healthcare system is constantly evolving. As healthcare and technology change, I prepare myself to be accepting of different standards.

In the Fall 2017 semester, I had the opportunity to learn more in-depth about Community Health Nursing. Caring for a patient in the community setting requires research and planning. To help a patient, one must know about the community that surrounds them. My clinical rotation took place at Kings County Hospital. I visited the diabetic, pediatric, women’s health, breast, and colposcopy clinic. This clinical experience taught me to be more open with patients and to increase my knowledge of cultures to be culturally competent. I have met all the expected behaviors of the clinical objectives that apply.

Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.

I demonstrated my professionalism by coming to clinical with the materials needed for the day and being prompt.  I prepared for clinical learning by having a notepad, pen, and stethoscope. I asked the nurse the reason for the client’s visit before calling them in. I dressed business casual with a lab coat. This was a change from how I had to dress in the associate’s program. Now that I am a licensed nurse, I had more independence in the clinical setting.

I maintained client confidentiality by not discussing my clients for the day with anyone other than the nurse I was partnered with or my clinical peers and instructor in post-conference. When viewing a client’s medical records, I made sure others were not around. I assumed responsibility for my own learning. When there were no patients, I asked the nurse about what is usually done when there is a patient and was given materials to read. I completed assignments within a designated time frame. I called clients in and took their vital signs. When I was unsure about a procedure, I asked the nurse or doctor to explain it to me. In the beginning of the semester, I did not participate as much as others in pre-conference. I like to observe and take in all the information to ponder on it. As the semester progressed, I started to share more. I realize that sharing my experience with others can help bring awareness of strengths and weaknesses in the community, as well as in yourself.

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

 While working with clients of various ages, I was able to employ analytical reasoning as critical thinking skills. When I worked with the nurse in the diabetic clinic, I was fortunate to witness the nurse consult with several clients. While she did her teaching, she allowed me to chime in with any thoughts. One female patient came in for a follow up on the A1c level and the management of diabetes. In the file, it showed that the client had a wound on the foot since the last visit. I noticed that the client was wearing open-toed slippers. The nurse told me that it was a good observation and we taught the client the importance of wearing close-toed shoes to protect the feet from injury.

Assessing the impact of developmental, religious and spiritual influences was difficult to obtain given the short interactions with the client. I was able to assess the cultural and emotional influences on some client’s health status.  A female patient came in with a high A1c level. The nurse counselor asked the patient what foods they eat and they listed all the good foods you would like to hear. When the patient was asked about foods like jerk chicken and roti, they replied, “Yes, I do, sometimes”.  The nurse and I were familiar with the food selections in the neighborhood. East Flatbush consists of predominantly Caribbean people. The food in Caribbean culture is high in sodium, fat, and carbs. Culture plays a big role in the diet of individuals.

There was significant data collected to assist these clients. Area-specific physical assessments were performed on select clients. Although the client cheated by eating certain dishes, the client was still determined to have their A1c at an acceptable level.  The client wanted to be healthy so they can live longer to see their grandchildren grow up.

The top priority for the clients was safety. During this clinical experience, I did not administer any medications. I evaluated the outcomes of nursing care by asking the patient questions afterward. One intervention was to teach a female client what to do and what not to do after a colposcopy. These instructions were important so the client will not bleed afterward and introduce bacteria that can lead to infection. I utilized principles of personal safety when working in the community by washing my hands before and after patient care.

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.

Therapeutic communication skills were used with individuals on a weekly basis in the clinical setting. Therapeutic communication was certainly needed when communicating with patients in the breast clinic. The clients were worried about the lump they found in their breast tissue.  Talking through the steps and even offering therapeutic touch gave the clients a piece of mind.  When I communicated, I paid close attention to my audience. When I had children as clients in the pediatric clinic, I used language that they could understand. One client was afraid of needles so we kept him talking about his favorite show, Dragon Ball Super to ease the client’s nerves.

I was able to communicate clearly and effectively with my instructor, peers, and the healthcare team. We had interesting conversations during pre-and post-conference. In the conferences, we spoke about the objective for the day as well as common problems we observed in the clinical site. I communicated data such as vital signs to the healthcare team, as well as documenting the vital signs. I briefly discussed my clients for the day with my peers and instructor.

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

 When teaching was implemented for an adult and/or family, it was done in a quiet environment. One problem that I noticed at Kings County was that the nurses were always interrupted by another employee. It was rare that someone did not knock on the door to come in for a few seconds.  For our service learning project, we had a model of a breast and a cassette tape to show a video. We realized that many women in the breast clinic did not know why they were there. Some did not know how to assess their breasts while others just didn’t do it.  We taught about self-breast examinations. We used return demonstration to assess their knowledge.

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

We utilized informational technology by using the internet to research information for individuals and families in the community. During this clinical, I did not use any form of electrical documentation. I did keep my own notepad of notes I used for the week.  This included baseline vital signs, medications and subjective data from the client. I maintained strict confidentiality with client records by handing the vital signs directly to the nurse. I did not share the client’s information with any worker who was not involved in the client’s care. I also made sure not to speak about the client’s condition outside of the clinical area.

Objective 6: Demonstrate a commitment to professional development.

 I demonstrated a commitment to professional development by continuing lifelong learning. This consisted of me researching information to share with my clients and increase my knowledge as a nurse. In the clinical setting, materials used were in English, Spanish and Creole. I used current literature to further my learning. I have read Nursing 2017: The peer-reviewed journal of clinical excellence. Graduating school does not mean the learning experience is over.  Healthcare is evolving and as a professional, it is essential to keep up to date with information. When I was confronted with a procedure I did not know about, I asked the doctor about it, took a pamphlet and did research at home.  I engage in self- evaluation because it helps me to grow. If I do not self-evaluate, I cannot reflect on my progress. I am willing to adjust to the challenges of independent practice in community health nursing.  Working in the community will definitely be a challenge because I really have to take everything into account. It is necessary to know the community and the people who dwell in it. Knowing the health of the community can give insight into planning care.

 Objective 7: Incorporate professional nursing standards and accountability into practice.

 I utilized American Nurses Association (ANA) Standards in clinical practice and complied with the standards of the hospital. I did not work outside of my scope of practice. I used the nursing process when planning care. Sticking to the guidelines helped me have a desirable outcome for the client. I was accountable for my actions and was aware of the hospital’s mission. My clinical group was told the hospital’s mission on the first day of clinical at orientation.

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

I collaborated effectively with the health care team to address client problems by discussing my observations and asking questions. For a patient that was diagnosed with stage 2 breast cancer, I identified the Susan G Komen website as a resource for the client. The breast care helpline 1877 GO KOMEN can be used for local or telephone support programs. Another client from the breast clinic was assisted to make connections with another clinic to get a sonogram of the lump found in the breast.

The patient with diabetes was encouraged to cut back on certain foods. Instead of having mostly carbohydrates on the plate, half the plate should be vegetables. The nurse and I showed the client the My Plate to give them an idea of the portions of food.

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

 A good thing about Kings County is that you would not be denied care if you do not have health insurance.  However, I recognized a few gaps in the care system. When a client needs to schedule an appointment, they are told to go to a different floor to schedule the appointment. The system of scheduling appointments at Kings County is not accessible. Several of the clients that came into the different clinics were not aware of why they had the appointment. Clients are leaving the clinic not completely sure about their discharge instructions. These problems can be fixed by having appointments made on the same floor. Clients should be given instructions thoroughly. Clients should teach back the health care provider to ensure that they understand what it is transpiring.

In East Flatbush community, there is a lack of nutritious food stores. Across from Kings County Hospital, there is a chain of different fast food restaurants. The nearest health food store is over 10 blocks away. It is not surprising that many patients that come to the hospital have diabetes. It has been found that one in six people in East Flatbush live below the poverty line. This limits their access to care and making nutritious food choices.  The community is in need of more fruit stands and markets that are accessible and affordable.

My experience at Kings County Hospital was eye-opening. I have lived in East Flatbush all my life and was blinded to certain things because I was accustomed to it. Doing the community windshield survey helped me to the realize the resources that East Flatbush has and also what the community needs. The clients in this community are in dire need adequate teaching. Our community service learning project will help women to be aware of changes in their bodies and the steps to take when an abnormality is found. Community health nursing has taught me that it “takes a village”.  Partners are needed to see a change. I will utilize the tools I gained in this clinical experience moving forward.