Clinical Self-Reflection Narrative
Sandra McKenzie
Being a student in a four year degree nursing program, I am required to take courses that will prepare me as a nurse to take care of clients in the community and collaborate with other health care professionals. This semester I am taking community health nursing and my clinical is at the Stein Senior Center, located at 204 East 23rd street NY, NY 10010. My classroom and clinical experience at the Stein Senior Center has enhanced my knowledge greatly. It was self-gratifying, rewarding and an interesting learning process working with the seniors and my fellow classmates. I was able to practice skills and information learned from class discussions and textbook readings with my classmates in preparation of our service learning project. In this self-reflective narrative I will discuss how I achieved my nine clinical objectives.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
During each clinical visit it was imperative that I demonstrated professionalism through my personal behaviors and appearance. I made sure that I was dressed professionally for each clinical visit, but comfortably enough to participate in the physical activities. Being punctual for class and clinical was of great importance to me, it was conducive for my learning experience. I had to assume responsibility for my own learning by reading the required materials prior to the start of each clinical session and class. I stayed on top of tasks by completing assignments within the designated time frame. Participating in clinical conferences allowed me to ask questions and voice my concerns and opinions. I sought guidance from my professor and team leader when necessary in completing group tasks and assignments. I was able to demonstrate client confidentiality by practicing the HIPAA policies and regulations. For example during clinical conferences I did not mention the names of seniors when discussing personal information divulged to me during phone conversations.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
During my time at the Stein Senior Center I participated in blood pressure screening and strength exercise. I was able to evaluate, reinforce and educate the seniors on their diets while serving them nutritious meals. There was a senior who had an elevated blood pressure; I assessed both arms to make sure that the reading was accurate. I then instructed the client to take her medication at this time. Within one hour of the client taking the medication, I checked the client’s blood pressure again and it was now within normal limits. I reinforced the importance of taking the medication as prescribed by the doctor the, and limiting sodium intake. The client verbalized an understanding of theses instructions. In the society that we live in, culture, religion, and spiritual beliefs influences our eating habits. It is important for nurses to continually educate the clients on the importance of adhering to a balanced nutritious diet. I made house calls to homebound seniors where I was able to obtain information regarding their ability to perform activities of daily living, social services, and home care. While working in the community setting it is important to maintain personal safety at all times. I was always aware of my surroundings and new where all exits were located in the event of an emergency.
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.
At the Stein Senior Center I was able to utilize my therapeutic communication skills with the clients and their family members. To communicate effectively with the clients I had to listen attentively, reflect back information given and clarify to avoid miscommunication. I spoke with the seniors about how they were doing and asked if they had any questions or concerns. I spoke in laymen terms and used open ended questions when corresponding with the clients. I notified my professor of any issues that the residents brought to my attention, and tried to resolve any health concerns or issues that they had. Documenting and reporting any concerns mentioned during the interaction with the clients, is also a form of communication between the professor, the director, myself and fellow classmates during post conference.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
At the Stein Senior Center we coordinated a health fair with the assistance of our professor and the director. There were different vendors present with information regarding health and wellness. NYU Dental provided free dental screenings for the clients. A physical therapist was also at the fair and gave out free samples of topical analgesics to the seniors. The NYPD spoke with the seniors regarding personal safety and ways to avoid becoming a victim. By having the health fair, research has shown that providing information can influence a person’s behavioral pattern regarding their health and wellbeing. The health fair promotes an awareness of the different resources that are available to the clients in their community. It allows the client to be proactive in making decisions regarding their health care.
Objective 5: Utilize informational technology when managing individual and families in the community.
During my time at the Stein Senior Center we used informational technology to gather information about the demographics and health disparities of the community. We used the internet to gather information. We utilized the principles of nursing informatics in gathering pertinent information regarding health disparities, which has an impact on the wellbeing and health of the community. We learned that asthma was the number one health disparity in this community, which can be related to the environmental pollutants. Any information that was used in obtaining patient information was done without using client identifiers.
Objective 6: Demonstrate a commitment to professional development.
Returning to school to obtain my Bachelors of Science Degree in Nursing is one example of my commitment to professional development. Upon completion I hope to obtain my Masters Degree in forensic nursing. As a part of my continuing education I researched the demographics of the community in which the Stein Senior Center was located. I learned that a large portion of this particular community suffered from asthma and other respiratory disorders. As a part of my research for my service learning project, I surveyed the community to locate all of the hospitals and clinics in the area. I also used my textbook and class lectures to prepare me in advance for the upcoming clinical days. I used web sites supported by clinical evidence. It prepared me in how to perform in the role of a community health nurse. I realized that as a nurse, learning is a continuous process, and in order to stay abreast of the advancement of technology and the ever changing health care system, we need to continue learning by doing research, using evidence based practice, and taking continued education courses. With the knowledge gained from this class and clinical sessions I am aware of the roles and responsibilities of a community health nurse in serving the community.
Objective 7: Incorporate professional nursing standards and accountability into practice.
As a nursing student you are taught the importance of using the nursing code of ethics in practice, and the utilization of the American Nursing Association Standards of practice. We are taught as nurses to do no harm. In preparing for my first clinical session I researched the mission statement of the Stein Senior Center in order to learn their goals and objectives. The Stein Senior Center’s mission statement is “to cultivate friendly relations among the members of the Stein Senior Center and the general public; to provide services with an emphasis on group growth; to share the strengths, and wisdom of senior citizens; and referral services, and to safeguard the health and wellness of senior citizens.” During my sessions at the Stein Senior Center I maintained a professional and respectable relationship with the seniors at all times. I followed all rules and regulations put in place at the Stein Senior Center. I performed my duties under the guidance and supervision of my professor.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
Working with my classmates as team members in planning the health fair we were able to provide information by identifying health issues and concerns among the seniors. I communicated with my professor and fellow classmates regarding the planning and implementation of the health fair. There were multiple vendors at the health fair which provided the seniors with information regarding their health and health concerns. The seniors were able to sign up for health insurance, receive free dental screenings, learn about their qualifications in obtaining home health care services, and obtained free samples.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
The role of the community health nurse is to asses and build relationships with the community, therefore acquiring pertinent information regarding their health status to advocate for the necessary resources needed to maintain a healthy lifestyle. As a nurse you learn to recognize that social economics, politics and social demographics plays an important role in the accessibility to quality resources and health care services. In a country as rich and developed as America, we have the greatest rate of homelessness, people living in poverty, lack of health insurance and health disparities. We realized that once you get local businesses, politicians, hospitals and health care providers involved you will be able to address many concerns and issues that the community may face. One issue I noticed was that a few of the seniors had issues with hypertension. A healthy diet, physical activity and the weight reduction of at least ten pounds will help to decrease hypertension.
Summary
My clinical experience at the Stein Senior Center was amazing. I enjoyed participating in activities such as blood pressure screening, strength exercise and serving nutritious meals. I learned how important it is to listen and assess the needs of the community. I recognized the impact that stakeholders have in obtaining the necessary resources for the community in planning and implementing my service learning project. I realize how effectively communication and working as a team can affect the success of planning a health fair. The knowledge that I have gained will help me as a dialysis nurse working in the hospital and community setting. The service learning project will serve as a tool and guide for other students, health care providers and community members in providing and maintaining the health care needs of the community. I want to thank my professor and classmates for making this a wonderful clinical learning experience.
