My Self-Reflection Narrative of Service Learning Project

Introduction:

I understand that as community health nurses, we play major roles in promoting health, preventing diseases and maintaining people’s health condition in the context of community. My clinical rotation in Harbor Hill Senior Center provides me a great opportunity to practice as a community health nurse and integrate my nursing knowledge into my practice.  In my self-reflection narrative, I am going to share my clinical experience by demonstrating how I fulfill the clinical objectives.

Objective 1: demonstrates individual professionalism through personal behaviors and appearance.

I am a nursing student and also a Registered Nurse, so I understand that to dress professionally and appropriately not only gives the professional impressions but also shows respect to the seniors in the center. Before I go to clinical, I always make sure I have my essential tools ready. For example, stethoscope, blood pressure monitor, index cards, note book and assessment forms, etc. I always attend in clinical on time and no absent.  I understand the importance and the legal responsibilities of maintaining confidentiality for clients. Therefore, I never discuss clients’ information with anybody in the public area. When I do assessment for the clients, I always make sure to maintain privacy by talking to clients in a private room. All the documentations and forms with clients’ information will be safely filed and stored in the coordinators’ office. Learning is an ongoing process; it doesn’t just limit to the text book and school. I found myself gain more knowledge through communication and interaction with my clients, staffs, my colleague and my clinical instructors. I always complete my assignments on time, for example preparing for the presentation, etc. When I have questions or not sure about my answer is appropriate to my clients, I would ask the clinical coordinator or supervisor; for clinical questions I would seek clarification from my clinical instructors. 

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

 

I collect clients’ information by interviewing them, reviewing their medication and the medical information they provided to me. Most of the Clients in the center are Chinese, so they are in the same culture like me. It provides me the advantage to understand how the impact of cultural, religious and spiritual influences on their health status. However, every individual is unique. Even they are all in the same culture, that doesn’t necessary mean they have same level of compliance of medication, comprehension of their health condition. I am glad that I am able to communicate with them by speaking the same language, and being more approachable to them since they feel more comfortable to talk to me, and provide me the information that is needed for client-care. I perform physical assessment for some clients that are on the critical care list that coordinator provided to me. Prioritization is always crucial in nursing, no matter if it is in acute care setting or community. For the home visit, my colleague and I always make sure we see the client on

the critical list first. We have very limited time in our clinical with numerous of task, blood pressure screening, home visit, rehab screening and presentation, etc.  We set our goal and plan at the begging of our clinical, and implement these task based on the priorities. We do not administer medication and treatment in the senior center, but we provide medication teaching and disease education. We evaluate the outcome of the intervention by giving out the survey questions after presentation, ask clients to show us how they manage self-administration of medication, encouraging them to ask questions, etc. Community health nursing is based on reflective practice, each client has different health needs, some of them need medication education, some of them need assistance for ADLs, some of them need social supports, and we work together with social workers and clinical coordinator, to make sure our provision of cares meet their needs with their best interest.

 

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 integrate cultural competence into the communication with our clients, and I maintain cultural sensitivity when talking to clients. In addition, I try to remain nonjudgmental, listen actively, maintain good eye contact, use silence, and encourage clients to explore their experience, show accepting and give recognition. I will clarify the messages with clients if I’m not sure I understand what they mean. Asking clients to verbalize what they perceive and encourage them to ask questions because communication is two ways. Misunderstanding can lead to serious results I communicate with my instructor, colleague and other staffs in the center clearly and make sure we are all clear and understand each other.  For those clients who don’t speak English or Mandarin, I will use translator to make sure everything was understood. I always make sure my assessment and nursing intervention are accurately documented.

Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence-based practice.

I develop teaching plan based on client’s diagnoses, culture, family and home aide availabilities. I use simple sentences for the teaching. The teaching is conducted at the client’s home with quiet, comfortable environment. At the end of the teaching, I always ask questions to make sure they are comprehend what was taught, sometimes re-teaching is required. I will use “ConsultGerirn” as reference for my assessment tool and establishment of nursing care and teaching plan for elderly.  

Objective 5: Utilize informational technology when managing individual and families in the community.

Informational technology provides convenient access to timely information.  Combination of computer science and nursing science is designed to assist in the management and processing of nursing data, information, and knowledge to support nursing practice and delivernursing care. I use reliable internet sources, school library, and online databases to access the information related to my nursing care and practice in the community. I always make sure to maintain confidentiality with client records. I only show and discuss clients’ information/situation to the team members who are involved in the case. 

Objective 6: Demonstrate a commitment to professional development.

I understand that ongoing professional development is the core to the foundation of the professional nurse. Applying our knowledge to practice, and ongoing learning are demonstrated through achieving and maintaining clinical and academic advancement. I am in a RN-BSN program, and planning to apply for a graduate program. In order to advance my nursing knowledge and skills, I keep updated by reading our textbook, nursing journal articles, attending continuing education programs and special training classes or seminars. This doesn’t only benefit my professional development but also our clients. I realize it is very important to have self-awareness which includes recognition of my biases, prejudices, and assumptions about individuals who are different. In the community health setting, independent practice is more emphasized, therefore as teaching and advocate are two significant nursing roles in the community, strong foundation of knowledge and skills are demanded.  With reformed health care and development of managed care insurance, I pay close attention to the news that related to health care field, because I believe that for a community health nurse to be affective, not only are nursing knowledge and skills important, but also a variety of health resources, updated healthcare laws and information.

Objective 7: Incorporate professional nursing standards and accountability into practice.

.As a Registered Professional Nurse, I understand the importance of being responsible and accountable for my actions in the clinical area. I always incorporate American Nurse Association standards in practice. ANA provides information on professional nursing policy, code of ethics, improving patient care environment, expanding our personal development, continuing nursing education, etc.  I also comply with the missions, values, and standards of practice of this organization.

Objective 8. Collaborate with clients, significant support persons and members of the health care team

I am a team player. I understand that as community health nurses, we can’t work alone no matter how efficient we are. In order to provide the cares that meet clients need, coordination is a key. I work with a wonderful team in Harbor Hill Senior Center because every staff here is so supportive and friendly.  We always have effective communication and work together to resolve client problems and when I am in the center, I am not just a nurse; I am also their friends and granddaughters.  The process of nursing initial assessment helps me to identify the needs of the clients and therapeutic interventions that will be appropriate. As community health nurses, we are also educators who familiarize the client and family of the resources that are available and how the client can benefit. This is important because without family knowledge and support, therapeutic interventions are less successful. I teach my clients of healthy lifestyle and encouraging them to eat healthy and do more exercise. Sometimes it is challenge for clients to change what they used to eat, so I instruct them for alternatives. I don’t just teach them what to do; I also explain them and make sure they understand the rationale. Most clients have very limited resources for other community agencies. For instance, some clients need physical therapy, but they refuse the service due to the difficulty of ambulation, so we refer them to the rehabilitation facilities that provide home visit.   

objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.

 As the development of managed health insurance and reformed health care system, I understand that the economic, political, social and demographic forces definitely have their impact on the delivery of health care services. Due to the high population of immigrants, language barrier, poverty, cultural diversity, lack of resources and support system can be the gaps in health care system. Most of seniors in Harbor Hill are Chinese, and some of them are Spanish. Due to language barriers, they are not able to read the letters that were sent from government agency or insurance company, therefore, they may miss out the important information, so we refer them the agency that is able to have free translation service. Some seniors have insurance problem, some of the medical treatments or medication are not covered, and some of them need adjust the home health aide service hours, etc. As community health nurse, it is my job to guide them to the right place, find the needed resources for them. As community health nurse, being an advocator is challenge. I realize my knowledge is very limited at some points, but as I am learning, working and exploring, I am expanding my knowledge and helping my clients and their families to seek the available resources that meet their needs.   

 Conclusion:

 I have a great experience of my clinical. Through the rotation in Harbor Hill Senior Center, I found the differences between working in acute setting and community. In my opinion, community health nurses work more independently, confront with more complexities and challenges. Through my rotation, I have improved my critical thinking, communication skills and nursing knowledge by fulfilling all the clinical objectives and self learning projects. I know my knowledge and skills are very limited. Thus, as a nursing student, I am committing to my academic learning; as a Registered Nurse, I am engaging to the ongoing professional development. I believe that it will be an amazing experience to work as a community nurse to help, to educate and advocate the citizens in the community, and therefore to achieve the goal of disease prevention and health promotion.