Community Health Nursing: Self Reflection
Community health nursing focuses on improving population health by emphasizing disease prevention and maintenance of health. For my clinical rotation in Community Health Nursing this semester I applied my clinical knowledge and expertise in health care to maneuver the multi-faceted branches of community health nursing such as educational, economical, environmental, cultural, physical and social factors to assess, and identify accessibility of necessary resources for the community. I had the opportunity to practice as a Community Health Nurse at the Penn South Housing Community in Manhattan. For this group project, there were nine objectives that had to be satisfactorily met. They are:-
- Demonstrates individual professionalism through personal behaviors and appearance.
The obligation to protect and maintain the confidentiality of patients’ health information is mandated by law in every state under the Health Insurance Portability and Accountability Act of 1996 (HIPPA). I acknowledge that obligation and practice with the best intent of maintaining full confidentiality of the health information shared with me by the seniors at the Penn South Community. In this clinical rotation each student nurse have been assigned one client to whom we visit once per week for one hour. Using the information gathered from the previous week’s visit I research evidence based practice journals and my textbook to get answers to questions on healthcare that my client may have. This also helps in completing assignments within the designated timeframe and with clarity on the subject. It is important to be punctual to clinical as well as at the workplace, therefore I am committed to being on time so that I do not miss out on the pre-conference with the group and the professor. In the community setting, there is no need for uniforms and scrubs but we do maintain professional business casual attire and carry the necessary tools with which to do clients’ physical assessment.
- Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community.
In the Community setting there is no medical records as would be found at a hospital; neither was there a need to administer medications. Therefore, I encouraged my client to share any concerns about her health and gave her the assurance that all information will be held in strict confidence, with the exception of any issue of self-harm.  Using my critical thinking skills developed in nursing school, I carried out general assessment on the living condition of the client, education level and knowledge of her health status. This information was then analyzed using evidence -based practice. In this case, it was interesting to see that I would have been wrong in assuming that based on the level of education and the eloquence of speech, that the client would have garnered a better understanding of her health care needs.   I made suggestions and asked that she discussed them with her primary care physician before implementing them.
- 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 is defined in the medical dictionary as the face-to-face process of interacting that focuses on advancing the physical and emotional well being of the client. Nurses use therapeutic communication techniques that encourage the client to express feelings and ideas and that convey acceptance and respect.   This interaction is valuable in maintaining a care-giver/client relationship of trust, safety, and comfort for the client. At Penn South I greet my assigned client with a smile, re-introduce myself and sate the reason for my visit every week when I visit her in the home. With the knowledge that seniors may suffer deterioration in sight and hearing, I sit at eye level and speak slowly and clearly and gives her time to process what is being said and to give a response. Sometimes it is necessary to maintain a longer pause by just sitting in silence. As part of the training it is necessary to communicate with the administrative staff,  at Penn South to report concerns and needs that the Community may provide. This is always done in a profession manner.
- Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
The group of student nurses has established an environment conducive to learning for the residents of Penn South with the direction of our professor and the assistance of the administrative staff at Penn South. We collectively created an event that we called “Hack a Snack.” The idea for the event came about after assessments were done and we realized that the seniors would benefit from learning about healthier ways to snack. Flyers were distributed throughout the Community. On the day of the event, the nurses shopped at the local supermarket (to prove local availability) for snacks that we offered to those who attended. We each presented teaching on topics such as diabetes mellitus and hypo/hyperglycemia, hypertension, and hyperlipidemia. These were the areas that were determined to be in need of the most teaching. We also distributed educational handouts on the topics discussed as well as quick and simple recipes, and a post-event survey that the nurses will follow up on and give further teaching if necessary.
- Utilize informational technology when managing individual and families in the community.
The Penn South Community is strictly residential with an activity center that caters more on the recreational needs of the community such as yoga, and tai chi; entertainment such as movies and music; and information sessions where the residents can get information and relay their concerns. We used our personal computers and cell phones to plan and organize our clinical days, print flyers and recipes and necessary information from evidence-based sources for teaching the residents. In the course of carrying out my clinical assignments, I kept confidential all information shared with me by the residents and did not disclose any information in or outside of the Community.
- Demonstrate a commitment to professional development.
I am fully committed to professional development in my career as a nurse and acknowledge that it is a career of life long learning. Therefore, I continuously seek out new information from evidence-based literature. Assignments include reading the textbook, postings on the discussion board, blogs, and journals as well as active participation in classroom discussions. The group participate in a pre-conference when each student nurse will state a plan of activity for that day’s clinical visit, as well as a post-conference when we each give an account of what took place, how we responded, and make any recommendations. The group always benefit from the positive feedback from our professor.
- Incorporate professional nursing standards and accountability into practice.
The mission of the Penn South Community is “to improve the quality of life for all residents.”  I am accountable for my actions while in this clinical area and to be sure that I am practicing within the nursing scope of practice I utilize the American Nurses Association Standards, (ANA). The standards include assessing, diagnosing, planning, implementing, and evaluating. Complying with these standards will help to improve the quality of life for the residents. I also understand that in the community there will be others with cultural backgrounds that are different from my own, therefore I must self-educate and be culturally sensitive in order to provide the best care in the community.
- Collaborate with clients, significant support persons and members of the health care team.
After identifying the health problem and based on the information received from the client I realized that there were a number of people involved in the care of my client and there appeared to be little or no communication amongst them. I was able to identify resources for my client, make recommendations for treatment choices which in turn lead to a more comfortable and appropriate lifestyle change that made a significant improvement on the client’s health. With some encouragement the client has started to venture out of her apartment for a stroll around the Community on days when the weather permits. She also seeks out information from other sources and even started utilizing the amenities at the community center.
- Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
Based on research of the Penn South Community, my group of nursing students have identified that the impact of economic, political, social and demographic forces have effects on the delivery of health care services in the community. While it is a fact that the community is in “in upper class” status, the constraints on health care accessibility are still evident. As a predominantly retired community of residents who live on a fixed income, the fear of being turned away because of not having adequate health insurance coverage, keeps them from seeking out preventative care. As a result minor problems turn into bigger and more debilitating illnesses.
As this clinical rotation is winding down to a close, I reflect on the exposure that I have had and the new things that I have learned, the areas that I need to focus on in my education, and the realization that community health nursing is the type of nursing that should be practiced now. Seeing clients in familiar settings results in a better and more trusting nurse-patient relationship. It also allows the nurse to assess, diagnose, plan, implement, and evaluate an entire community, its environment and green spaces. The nurse can then advocate on behalf of an individual as a client or as a community as a client while maintaining professionalism and clients’ confidentiality. This has been a very refreshing experience for me thus far.
