Samantha Hernandez, RN

Introduction:
            This semester I worked at P.S. 184 located in Brownsville, Brooklyn with Professor Santisteban, my fellow classmates, and with P.S. 184’s preschoolers whose ages ranged from three to five years old. Our clinical group focused on implementing interventions and strategies to decrease childhood obesity, which is one of the leading health disparities that is highly prevalent within the Brownsville community. The faculty were cooperative in allowing my clinical group and I to do exercise activities and to teach lessons about healthy foods during the course of our semester. Collectively, our group came up with creative, fun, and educational activities for the children to do. As a result, I was able to meet nine of the following clinical objectives.

 Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
           During the course of the semester, I have demonstrated professionalism by being punctual, and meeting at eight o’clock in the morning sharp in nursing scrubs to work with my professors, classmates, the P.S. 184 preschoolers, and staff with a positive attitude. I was reliable and responsible by answering emails and meeting for pre and post conferences to discuss our health promotion activities for the children in a timely manner. I made sure each activity in my assigned classroom was organized by relating to the theme of the importance of healthy eating and physical activity, so that the children can easily make connections. I also demonstrated professionalism by maintaining the children’s confidentially by only discussing the children with the teachers inside of the classroom and keeping all names of children anonymous within this service learning project.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
           Before interacting with P.S. 184’s children and their families, I first did my assessment of the community and researched the leading health issues within the Brooklyn, Brownsville community from the New York City Department of Health and Mental Hygiene. This evidenced-based qualitative and quantitative research from the New York City Department of Health and Mental Hygiene and various organizations like Brookdale Hospital’s Live Light Live Right Program allowed me to effectively use my analytical reasoning and critical thinking skills to implement different strategies to promote healthy eating and exercise in P.S. 184’s effort to reduce childhood obesity rates. Educational materials and activity lessons used simple wording, so that the children and families of P.S. 184 can easily adopt healthy behaviors within their households.

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.
           In order to effectively communicate with P.S. 184’s preschoolers and their families regarding their health, I practiced active listening. I would ask and clarify questions, would listen attentively to what the other person was saying, and would rephrase what was said to me, so I was sure I would understand what was discussed within our conversations. Considering the preschoolers’ age group, I used as few words as possible, and I was clear and direct when answering any questions. I tried to be friendly and approachable to build trust with the students and the staff, so they felt comfortable to speak openly. As a result, I made sure my eye contact, body language, and tone reflected that.
           During my conversations with the children, I tried to convey empathy and open-mindedness by understanding and respecting their ideas and opinions to maintain productive conversations. I also asked questions to get feedback from the children during our activities and at meal times to understand the children’s point of view, as well as give them praise for their efforts and good work.
           I was not able to converse with the children’s parents one-on-one due to my clinical group’s differences in scheduling with the preschool program; however, I was able to communicate and keep parents informed of all activities by using simple, easy to read, professional language in the children’s take home notices. Obtaining each parent’s consent to all lessons and activities ensured that parents were responsive and open to change in their children’s scheduled routines. 

Objective 4: Establish an environment conducive to learning and use a plan for learners based on evidence-based practice.
            In order to establish an environment conducive to learning, I first researched what the preschoolers’ growth and development and developmental milestones are in Wong’s Essentials of Pediatric Nursing by Marilyn Hockenberry, so the activities and my communications skills would correspond to their level of learning and understanding. I incorporated healthy eating and exercises into the students’ Tuesday schedule and utilized the classroom and the gym as an environment conducive to learning.
           During the children’s story or coloring time, I read books or used coloring worksheets from Nourish Interactive to introduce the children to a healthy fruit or vegetable they would be learning about or eating during lunch. During lunchtime, I incorporated these foods with the permission of the children’s parents. The children learned the taste, look, smell, color, shape of the fruit or vegetable, and where it grows and comes from. Also, during the children’s playtime in the gym, myself and the other nurses incorporated different aerobic exercises like walking, skipping, hopping, dancing, and stretching activities from the First Lady Michelle Obama’s Let’s Move Program to get the children moving and engaged.

Objective 5: Utilize informational technology when managing individual families in the community.
            In order to raise awareness and education on increasing healthy eating and exercise in efforts to decrease childhood obesity rates, information was distributed to both the children and their families from P.S. 184. Handouts, educational materials, and flyers included information on food and exercise activities from educational websites and videos online like Nourish Interactive, Growing Healthy Children, and the First Lady Michelle Obama’s Let’s Move Program. Utilizing informational technology for all the preschool classes allowed myself and the other nurses to make sure that the children each had a chance to experience and have fun participating in the same health education and fitness activities.

Objective 6: Demonstrate a commitment to professional development.
            I demonstrated commitment to professional development by planning ahead, being present, following instructions, and most of all, trying to be creative in order to continue to get the P.S. 184 preschoolers engaged, motivated, and interested.
           During the course of the semester, my clinical group and I faced challenges during activities due to extra children who may have been in the class because teachers in different preschool classes were proctoring school exams or having conferences. As professionals, my classmates and I were able to overcome this hurdle and to persevere by supplying extra copies of coloring worksheets, eating utensils, fruits, and vegetables for the children to try if other students were to join our class. The ability to be flexible and demonstrate problem solving during activities has helped me in my professional development, and strengthened my commitment to continue to learn while facing new challenges.

Objective 7: Incorporate professional nursing standards and accountability into practice.
            I incorporated the professional nursing standards and accountability set by the American Nurses Association to advocate for the P.S. 184 preschoolers and their families. I encouraged the importance of healthy eating and increasing physical activities while remaining ethical at all times when complying to the policy and procedures of P.S. 184. Through the nursing process, I was able to assess, implement, and evaluate all of the educational activities that were incorporated to enhance P.S. 184 preschoolers’ learning experiences with the hope that these educational lessons will be incorporated into the future preschool curriculum.

Objective 8: Collaborate with clients, significant support persons and members of the health care team.
            During the course of the semester at P.S. 184, I collaborated with my professors, clinical group, and the teachers to plan and implement each activity with the parents’ permission. Through trial and error, my clinical group, the teacher, and myself had collaborated together to set aside time within the children’s Tuesday schedules to include our healthy eating and physical activities. Everyone worked collectivity to assist during meal times as well as in the classroom and physical activities at the gym. We did this in order to ensure a safe, supportive, and friendly environment where the children can learn. When the children reflected back on what they learned at the end of the day, we indicated that collaboratively, we were successful by their positive responses of why they feel healthy eating and exercise is important for their health, as well as the children’s ability to identify healthy food choices.

Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
            As a member within the nursing community, I recognized that care services are limited within Brownsville because it is a poor and low-income community. Keeping this in mind, it is important to educate Brownsville’s residents through the use of primary prevention measures to eliminate the disparity of childhood obesity within their community. In order to achieve this goal, education is key so both children and their families can learn to lead healthier lifestyles. I found programs and resources like Brookdale Hospital’s Live Light Live Right and Brooklyn’s Perinatal Network Incorporated are stepping stones to assist residents with children who suffer from childhood obesity. I think more community nurses as well as other medical, social, and political figures, need to continue to raise awareness to get residents within Brownsville to utilize resources to increase healthcare services. Schools like P.S. 184 have allowed myself and other nurses to continue our mission to decrease childhood obesity and I hope that this awareness will influence and pave the way for other schools, children, and their families to make a difference in their communities, starting with themselves.

 Conclusion:
            I learned from working in P.S. 184 that primary prevention measures such as healthy eating and exercise are the key to healthy behaviors, and it is an extremely important task for the nurse working in the community to motivate the residents within the Brownsville community to accomplish. I also learned that I enjoyed working and educating the children at P.S. 184, and I would love to work within the community at some point during my nursing career in pediatrics, or with expectant mothers because I think it would be very rewarding.
            I feel that the clinical setting and the didactic setting related to each other because both experiences focused on health promotion and maintenance, as well as disease prevention. Evidence-based practice is strongly applied in community based nursing, and I was able to apply my research from various organizations and programs that specialize in childhood obesity prevention as well as different evidenced-based quantitative and qualitative research articles as seen within my service learning project in the clinical setting as well as in the classroom. Also, I was able to learn the value of community health and its professional expectations, responsibilities, and accountability that are needed while providing ethical and transcultural nursing care in the community.
           As a nurse, it is important to advocate in poor and low-income communities like Brownsville, so they can become insured and informed of resources outside of the emergency department. Community nurses can then provide care that is needed within the community while hospitals in turn can contain costly care measures.