Tatyana Lekomtseva
NUR4010/HD22
Fall 2014
Dr. Aida L. Egues
Narrative Self-Reflection Of Service Learning Project
My clinical component of this course was done at the Stein Senior Center that is located in Manhattan CommunityDistrict Six. Stein Senior Center has been serving the older adults of New York City for 40 years. I think it is important for nursing students to have clinical experience in the community. By working with seniors in this community, I was able to educate them about health issues, explain proper nutrition, demonstrate effective safety practices, and promote healthy lifestyle. This self-evaluation piece is about my self-reflection on my clinical experience, my personal and professional growth, and my achievement.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
I think it is very important to demonstrate our professionalism where we work, where we study and during the clinical part of our classes. During my clinical time at Stein Senior Center, I followed HIPPA law and maintained clientconfidentiality. I didn’t mention client’s names or any private information about them on my four blogs or otherassignments. In addition, I didn’t discuss anything about clients with other seniors at the center. I always takeresponsibility for my own learning. I followed our unit objectives, clinical goals and the instructor’s guidelines at all times. All of the reading and writing assignments were submitted on time. I actively participated in all pre and post conferences, asked questions for clarification and sought guidance from the clinical instructor appropriately. To avoid any lateness, I took extra time for travel and reported to clinical practice and conferences on time. I did dress professionally and appropriately for our clinical setting.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individual and families in the community setting.
During our time at the Stein Senior center, I was involved in several activities and communicated with many seniors. Bydoing all of these, I was trying to learn and get more information about the community itself, as well as people who live there and their community-based needs. I had the opportunity to talk with many seniors and ask them questions about all aspects of their health behavior including medications, diet, and exercise. All that new knowledge and information helped me better understand how developmental and emotional changes can affect the client’s health status. During our interaction time with seniors, I did show an interest in their cultural and religious background by asking questions aboutthe traditional food, holistic medicine and health beliefs. As a nurse, I need to collect appropriate history information from the client and perform accurate physical assessments to form a thorough and organized database for client care. Then, I would analyze data to identify appropriate nursing diagnoses and prioritize care based on analysis data. The majority of nursing interventions that I implemented safely were teaching interventions such as: fall prevention strategies, how to use the walking aids, high blood pressure complications and Dash diet. Effective teaching-learning strategies were used during our Fall Prevention presentation. In addition, pre and posttests were given to seniors to determine the effects of our presentation.
Objective 3: Effectively communicate with diverse groups and discipline using a variety of strategies regarding the health needs of individuals and families in the community setting.
Communication is essential to all nursing roles and in all nursing settings, especially in the community. To improve mycommunication skills with seniors, I did communicate with them in a warm and friendly manner, I showed interest intheir concerns, listened to them and provided clear and useful information. I also used visual aids such as pictures anddiagrams, and even visual demonstrations during our group presentation to help clarify and reinforce comprehension of our main points. To avoid any miscommunication during our clinical time I reported significant information such as high blood pressure to our clinical instructor. To avoid any stereotypic beliefs about older people, I did start our conversations with a few questions to engage seniors in a brief dialogue. This short conversation in the beginning provided more accurate information for assessing older adults ability to comprehend English, cognitive ability, visual and hearing ability. If I suspected that seniors have hearing problems, I would increase my speech volume and speak a bit more slowly without any shouting. During my interactions with the older adults, I also avoided using terms of endearment, simplified language or a medical jargon.
Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence-based practice.
As a group, we developed and implemented several teaching plans for seniors at this center including Fall Prevention, Diabetes, Dash Diet, and Medications Safety. Personally, I developed a teaching plan for our project “Fall Prevention” based on evidence-based practice. I utilized a variety of resources including systematic reviews to incorporate evidence-based practice into a teaching plan. As a nurse, I know that age-related hearing loss makes it difficult for older adults to understand and remember speech in the presence of background noise. When talking to older adults, I did make sure that the surrounding environment was as quiet as possible. That’s why a quiet private room was a better choice for all of us to check blood pressure, ask questions and provide teaching interventions. During our group presentation, we even used a microphone device for our listeners to hear and understand more about fall prevention tips and walking devices. I always asked the seniors if they have any questions after the teaching interventions. Pre and posttests techniques were used to determine positive effects of teaching interventions on seniors. After our presentation, I would like to revise a teaching plan for seniors by including teach-back techniques in my evaluation part. I think, teach-back techniques could be useful for confirming the older clients understanding of the information being provided during our presentation, especially for proper use of walking devices.
Objective 5: Utilize informational technology when managing individual and families in the community.
Technology can provide a great opportunity for having better communication between professional nursing practices, other health providers, and clients in the community. As a registered nurse, I have the responsibility to evaluate the various websites as viable sites for using them. I only used valid healthcare websites such as the PubMed Health website or the CDC website to obtain current information or to find the best clinical evidence for my nursing interventions and class assignments. None of my blogs or other class assignments contain confidential information from the work or clinical setting.
Objective 6: Demonstrate a commitment to professional development.
Nursing is a lifelong learning profession. I always used professional textbooks that were provided from our school and appropriate websites to find evidence-based information in planning care for seniors in our community setting. For this class, I got engaged in the self-evaluation assignment by writing a narrative self-reflection piece for our service-learning project. I think it can help me as a nurse to recognize my strengths, areas for improvement and professional goals. By taking this course, I learned that nurses who choose to work in the community need to develop a skill set that might help them to complement the multiple roles of care manager/advocate, leader/follower, teacher/learner, and consumer of evidence-based research. Communities are dynamic, and nurses must adapt to be able to provide patients with high quality care. I think I would be able to work in the community as a community health nurse and be comfortable with autonomy and constant changes despite the challenge of learning and balancing multiple roles.
Objective 7: Incorporate professional nursing standards and accountability into practice.
ANA Standards of practice include assessment, diagnosis, plan, implementation and evaluation. Our group was working together on a service learning project in Manhattan Community District Six. Using the nursing processes, our group completed the following activities: assessed needs and determined the main concerns of community; explored available resources and the capacity of the community; developed a set of diagnoses for problem resolution; then developed a plan to meet the needs of the community and worked with the community to implement the plan; and finally evaluated the goal accomplishment. As part of the group, I worked on areas of assessment that begins with assessing community-based needs. I collected information from multiple perspectives and learned about cultural, economic, educational, medical and social diversity. We also complied with the Stein Senior center standards of practice. For example, I only measured the blood pressure for seniors in the presence of our clinical instructor. Accountability refers to nurses being answerable for their actions. That means I am accountable for any actions that were performed by me in the clinical setting. In addition, I was ready to use my clinical competence and safe nursing care in the clinical area. According to the Stein Senior Center, their mission is to cultivate friendly relations among the members of the 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.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
As a group, we collaborated effectively and respectfully with each other by developing our presentations and working on the service-learning project. I verbally communicated client information to our clinical instructor when needed to address client problems. Health care resources were identified as a part of our service learning project. Health messages about appropriate lifestyle changes were delivered throughout our presentations: Dash Diet, Fall Prevention, and Diabetes. My part in the project was to inform seniors how to prevent falls where I focused on modifiable risk factors such as poor vision, problems with feet and shoes, home hazards, medications, and postural dizziness.
Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
The healthcare system in America is facing a transformation caused by many factors including the high cost of health care and the aging of population. A priority of health care relates to healthcare issues and clients, families, and communities who are either uninsured or underinsured. Many seniors complained to me about their health care coverage and access to health care. Seniors who are poor enough to qualify for Medicaid have a good coverage for their medical needs, but they can have problems with access to services because Medicaid reimbursement to health care providers is less than they can get from private paying patients. Seniors with higher incomes who are covered only by regular Medicare and private Medicare supplement insurance experience even more gaps in their health care coverage. Another barrier for many seniors is a lack of information about services and programs that are available. By working in the community, nurses are able to advocate, and coordinate the matching between the needs of their clients and appropriate health care resources especially for underserved communities.
Summary: Community Health Nursing is a didactic and clinical course that provides the main concepts required for practicing as a community health nurse. By taking this course, I was introduced to course objectives in the class setting together with the clinical experience in the community. Both, the theoretical and clinical learning experiences focused on health promotion, disease prevention and maintenance of health, as well as therapeutic communication techniques and challenges in teamwork. I definitely enhanced my analytical reasoning and critical thinking skills by planning and implementing a service-learning project in the vulnerable population community. I think it is very important to involve students in such big projects like the Service Learning Project. It is an excellent approach to integrate community experience with theoretical study of the Alliance for Health Model to enrich learning, teach the idea of evidence-based nursing in care delivery, and to create a composite picture of health and illness in the real-life community. I am very thankful to my course instructor for giving me the opportunity to gain the theoretical knowledge and extend my learning beyond the classroom, which helped me to change my whole impression about community health nursing.
