Self Reflection Narrative- Community Nursing
Samuel Slavin
New York City College of Technology
Self-Reflection Narrative
My clinical rotation site for community health nursing in the Spring of 2015 took place at P.S. 184 which is located in the Brownsville section of Brooklyn. I was part of a group of ten other RN students, along with our preceptor. Our objective was to see the positive effects a community nurse can have on a particular community of preschool children. After reviewing the needs of our community, we identified obesity and diabetes, as one of the greatest negative factors affecting this particular community. Our intervention was to introduce healthy food choices, at a young age and increasing physical activity.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
To me professionalism means taking one’s job seriously. I demonstrated this through my appearance as well as behavior throughout my time at the clinical rotation site. Since our location was a preschool, we wanted the children to easily identify us as the student nurses. Being that there are many different school employees, teachers and therapists walking in and out of their class throughout the day, our goal was to minimize confusion and allow the children to easily differentiate us. Therefore, our dress code was nursing scrubs with our school photo ID displayed at all times so we could be easily identified. It was heartwarming that already by week number two the children would call out, “Hi there Nurse Sam.”
Another factor of professionalism is confidentiality. Since client confidentiality is so important, we made sure never to use any child identifiers when discussing or blogging about our rotation.
In my day to day job, I mainly work with the geriatric community. Just last week, I visited a patient who is 104 years old!. Therefore to familiarize myself with this age group, I took responsibility for my own learning, by reviewing the expected goals and milestones of a preschool age student. This helped prepare me for my clinical learning as well. All assignments were completed and handed in, within the designated timeframe. Whenever I felt ill-equipped to deal with a child’s behavior, I made sure to seek the guidance of the classroom teacher, or my preceptor. The classroom teacher was a great resource and added a wealth of knowledge. For a half hour before the students arrived we had a preconference and discussed our goals for the day. We reviewed the healthy food choice topic that we would be introducing that day, as well as the physical activity that we had planned for gym time. I made sure to always be punctual, dressed accordingly and motivated to teach as well as learn.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Our main goal was to provide the students with healthy food choices. Therefore, we first needed to make sure that no students where allergic to any the foods that we would be introducing. We discussed with the teachers possible food options. If there were any students with a specific allergy or sensitivity to a specific food, we made sure that it would not be included. We also reviewed the planned physical activity, to make sure that it wouldn’t be too strenuous for any children with asthma. I took into account the developmental stage of the students, as well as their emotional, cultural, and spiritual influences. There is a direct correlation between a person’s culture and their food choices. Therefore, we made sure to always be culturally sensitive. While teaching about nutrition, we needed to assess their self-care needs. Are they able to feed themselves? Cut their own food? Pour their own drink? We observed this during mealtime. Any student lacking in any of the above area milestones, we took the time to assist them. Our physical assessment included measuring the student’s body mass index (BMI.) Results were sent home to the parents, explaining where their child falls on the BMI chart and what that means. For the students that didn’t fall in the proper BMI range, we gave them the tools to help them learn healthier options. We highlighted healthy diet and physical activity as obesity prevention. Our plan was that by introducing healthy choice at a young age, it will help insure the students will continue to make healthy eating choices throughout their future. Long term goals were unable to be presently assessed. However, short term goals have been reached through the student’s active participation as well as, palatable excitement each time we introduced a new healthy choice. One student, who had never eaten or even heard of a cantaloupe before, announced to the class, “I’m going to ask my mom to buy this for me the next time she goes shopping!” To introduce our healthy foods, we used a few age appropriate modalities. First, we presented pictures of the foods, then the actual foods, then we did a fun activity of creating fruit kebabs, and then we even showed them how vegetable are used in conjunction with other foods, like tomatoes used in pizza sauce. Before any handling of food, we washed our hands to show the children the importance of always washing our hands, before we eat, and we always wore gloves.
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.
I met my objective of effective communication by utilizing age appropriate therapeutic communication with the students we dealt with. Different modalities were used in the class setting and the children were always spoken to with respect in regards to their individual concerns and needs. The use of age appropriate langue is always important. As nurses we are so used to using medical terminologies when communicating with the other medical staff and at times we take for granted that our patient understands our verbiage. Working with Pre K children I needed to constantly remind myself to make sure I am using words that this age understands. I did notice that the children preferred to be part of the conversation and lost focus when lectured to. Once I involved them in the conversation by asking them questions and hearing what they had to say they ended up listening more and gained more.
I communicated clearly and effectively with my instructor, peers and school personnel in a professional manner.
Data that we collected included BMI measurements. The data was ascertained accurately and documented in a clear and understandable fashion. The results were discussed with my instructor and the school health care team.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
I met this objective by developing and implementing a teaching plan for students and parents in regards to healthy eating and increasing their physical activity levels. We are planning an end of year celebration with the students and their parent. Each class will perform a music and movement presentation to highlight the importance of physical activities. We will bring roses for the children to give their parents as a gift for participating. For our teaching to have long lasting effect we need the parents to continue and encourage healthy eating habits in the home. By providing a fun and celebrative environment to reinforce and reiterate the importance of healthy food choices we are increasing the chances of positively effecting our community.
Once a month the school has a healthy cooking session for the parent body. A healthy meal is cooked and demonstrated for all the participants. After the cooking, tasting and fun socialization the participants get to take home the ingredients to duplicate the meal in their homes. We encourage our students’ parents to participate in this venue and I plan on personally participating in one of these sessions before the semester is over.
Objective 5: Utilize informational technology when managing individuals and families in the community.
As part of my clinical experience I did not have access to any of the client records. Therefore, I was unable to utilize principals of nursing informatics or have the need to maintain confidentiality with client records. However, we did make sure to keep all student identifiers and personal information private.
Objective 6: Demonstrate a commitment to professional development:
I met this objective by keeping up to date with appropriate, current literature when planning the care for my community nursing environment. Some examples of the literature I found most helpful were peer reviewed research articles, and pediatric nursing journals. I also made sure to only do research on dependable websites.
I assumed responsibility for lifelong commitment to professional development, by joining nursing organizations. Joining a nursing organization is important because it will enable me to participate in nursing conferences locally, and eventually state wide. I hope to be able to continue having a part in representing and shaping our profession.
I continuously engaged in self-reflections by evaluating my nursing interventions, and critically thinking of ways in which I could have done the task more efficiently. For example, after conducting my physical activity session. I reflected on what went well and what could be improved for the next time.
While I am proud of my accomplishments and the goals I met in my community nursing class, I am committed to furthering my education, and striving to achieve excellence in my nursing profession.
A community nurse has to be flexible and easily adjust to the challenges of being an independent practitioner. A floor nurse has her colleagues, charge nurses, nurse managers, and nurse educators close by to reach out to for guidance and assistance. A community nurse is usually on their own. Therefore it is important for the community nurse to reach out to other community nurses and to keep up to date with the current evidence based practices.
Objective 7: Incorporate professional nursing standards and accountability into practice.
I met this objective, and adhered to my standards of ethical practice, by utilizing the American Nurses Association Standards in my clinical practice. I did this by practicing within my scope of practice, using the nursing process of assessment, planning, implementing, and evaluating. By working in different nursing settings, I have come to learn and appreciate how the nursing process is applicable in all areas of nursing.
I held myself accountable for my actions in the clinical area, and made sure to act appropriately within my role.
The core values of P.S. 184 are; Respect, Responsibility, Pride, Kindness, Determination, and Friendship. These are the core values that I strive to live by, while at my clinical rotation, and G-d willing in my own nursing practice.
The mission statement of P.S. 184 is, “To raise student achievement, improve instructional practices, and optimize school progress by providing all members of the school community with the necessary professional learning to create effective change.”
Objective 8: Collaborate with clients, significant support persons, and members of the health care team.
I met this objective by collaborating effectively with my peers, preceptor and educational school personal, when planning activities and interventions. I prioritized the students’ care based on their needs and therapeutic interventions. I made sure to provide customized care to the children’s unique circumstances.
While immersing myself in P.S. 184, it became evident that each student had different requirements. Some very much wanted our attention, while others were more reserved; wanting to play and do their work independently. Some students quickly joined the activities when I provided them with stickers, while others needed other modes of motivation. Surprisingly, most kids were excited to participate after I personally invited them to join.
I guided the students by introducing them to the concept of making healthy lifestyle decisions. Using clear, age appropriate examples, I successfully showed them how beneficial and valuable making healthy decisions would be in their daily lives.
Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
I met this objective by recognizing the gaps in the care systems of the community we worked with. We did this by assessing the needs of the clients in my community and recognizing the lack of medical specialist in the service area. For example, most students with asthma will go for treatment to the closest hospital which is Brookdale hospital. There are very few asthma centers or asthma clinics for the students suffering from asthma to be treated at. Having their asthma managed in the emergency room puts them on a revolving door cycle with their exacerbations being treated but the overall disease is not being properly managed. Another impact is the socioeconomically status of many of our community students which limits their ability to purchase healthy food, which is often more costly. Lack of stores that offer fresh produce and healthy food options is another problem. Most of the shopping is done at the local bodegas which don’t offer fresh fruit. Low parent involvement was another barrier for long term change. Most children are unable to make their own diet decisions. If the parents don’t agree with what we taught, the students at this age are unable to follow up with the healthy food choices we introduced.
The solutions for these complex problems in this population won’t be solved over night or over one semester, but with each positive encounter these students have with people who are looking out for their benefit it will give them the tools to eventually influence there other family members and give them the guidance to make appropriate life choices. I did participate in a community meeting where some of my nursing student colleges presented a proposal to politicians and community leaders to help bring a medical clinic and a recreation center to the community. Across the street from PS 184 there currently is two vacant buildings. It was proposed that the building should be turned into an asthma clinic where the community can have their disease managed and treated by asthma specialists along with a swimming pool, sports center and a kitchen which would teach healthy cooking methods and sell fresh healthy food to the community at large.
By working with the students at PS 184 I gained a lot of knowledge and insight about the different aspects of care that are involved in Community Health Nursing. I can indeed say that I learned a lot from my clinical experience and enjoyed the time I spent with the students, teachers and fellow nursing student at my clinical rotation each week. I am confident that I will be able to use this knowledge to help me further my nursing career.
