I am a nursing student we were asked to right a log based on our personal objectives chosen for our first clinical rotation at a community health clinic. Here are my objectives.
Clinic & Home Visit Objectives:
To orientate myself to the clinic, its facilities and surrounding area.
To identify and describe staffing and their roles.
To identify, observe and participate in the process of patient care / home visit within the clinic and surrounding area.
To identify, select and familiarize myself with a family/ person of focus for a family case study.
To make contact with the family selected for a family case study and arrange for follow up visits.
I wrote a log based on my objectives. The log was also to include an evaluation stating if the objectives were met and also to state what I would do different given the opportunity.
I do feel like I may have overwritten considering the log is to be only two pages. Can you help me paraphrase my log?
Here is my log:
To orientate myself to the clinic, its facilities and surrounding area.
At the beginning of my shift and immediately upon entering the facility I was greeted by a Security Officer who requested that I identify myself and proceed to the front desk. At the front desk there were two clerks. I was then instructed by a clerk to sign in and secure my belongings in one of the drawers provided. Immediately after, I proceeded to the back of the facility to an examination room where I met two nurses (Mrs. Duncombe & Mrs. McKenzie) and a nursing sister (Mrs. King). While there, I introduced myself which included my name, course description, year rank and objectives. I along with two other nursing students were orientated to the clinic in terms of its location within the community, surrounding area and history. The Fox Hill Community Clinic is located on Bernard Road at the Eastern end of Nassau, New Providence, Bahamas. This clinic is also adjacent to the Fox Hill Library and Sandilands Primary School. It was also shared that Fox Hill is one of many vibrant communities in Nassau and holds many traditions and historic buildings that brought all Nassauvians together. The residents in that community are loving and caring, and are affectionately referred to as ‘Fox Hillians’. In addition to being orientated we were also informed all facilities/rooms within the clinic and the differing days in which specialty clinics took place. The Fox Hill Community Clinic is relatively small when compared to other clinics on the island. It is composed of a reception area or lobby, a seating/ waiting area, a storage room, a pharmacy, (5) bathrooms, (1) doctor’s office, (3) Examination/ Interview Rooms and a room for Chronic noncommunicable diseases . When comparing the size of the clinic to the size/ need of the community; the days to which specific persons are serviced/ accommodated defers. Covid-19 protocols and restrictions also play a major role. The schedule to which specific persons are serviced/ accommodated is:
Monday- Home Visits
Tuesday- Family Planning / Home Visits (Evening)
Wednesday- Child Health (Well)/ Home Visits (Evening)
Thursday- Home Visits
Friday- Immunization / Home Visits (Evening)
Last Friday in Every Month- Gerontology
To identify and describe staffing and their roles.
The staff at the Fox Hill Clinic were adequately dispersed throughout the facility. Upon entering there is a security officer and clerk. The role of the security officer at the clinic is to maintain the safety and security of the clinic whereas the role of the clerk is to provide administrative support to the clinic. This includes tasks such as filing paperwork, answering phones, scheduling appointments, and managing patient records. Other staff included (2) nurses, a nursing sister, an auxiliary / TCN, pharmacist and (1) environmental staff. Their roles include but is not limited to the following:
Nurse- Provides assessments, treatments, medications, and health education to patients.
Nursing sister- Provides specialized care to patients and ensures the proper day to day functioning of the clinic. They may also provide additional and administrative support to other nurses and staff.
Auxiliary or TCN- Provides additional support to nurses/ other medical staff and assisting with medical procedures (E.g., Vital Signs & Patient Measurement Readings). They also provide patient education and help with administrative tasks if needed.
Environmental Staff- Maintains the cleanliness and safety of the clinic. This includes the cleaning and disinfecting of the clinic, disposal of hazardous materials, and inspection of equipment and facilities.
Pharmacist- Provides direct patient care using medicines and consultancy to improve health and wellness. The pharmacist also improves screenings and diagnosis, as well as manage long-term conditions in patients.
Other staff not present during this visit included a doctor who is responsible for providing medical care to patients. In doing so, they diagnose illnesses/ conditions, prescribe medications, and oversee treatments.
To identify, observe and participate in the process of patient care / home visit within the clinic and surrounding area.
During my visit, I was able to identify and observe several processess of patient care within the clinic. As stated above, Wednesdays are allocated to Child Wellness Visits (sick children/ infants are not seen at this clinic). These visits comprised of immunizations and scheduled developmental checkups. When arriving at the clinic, all children were accompanied by a parent/ guardian. The appropriate documents were provided to the clerk who would then register the child for the day’s visit. After registration, the child would then be assessed by the auxiliary. During this time their weight and height was taken and recorded on a piece of paper to be presented to the nurse during the pre-visit interview. During the pre-visit interview, the nurse would assess the child’s appearance, gather information from the parent/ guardian when applicable and document/ chart accordingly. Some areas of focus during this assessment were the child’s growth rate, eating and social habits. During this time any concerns stated or observed would be documented accordingly as well. After observing, we as the nursing students were given several opportunities to participate in the interview and assessment process. Once understood properly, I found that it was very easy to complete. The second part of the visit was for the parent/ guardian to accompany the child into another examination room. While there, another nurse along with the nursing sister assessed the child’s notes. During this process, it would be determined which immunizations were needed/ can be administered. Immunization administration varies according to age, allergy status and past immunization record. Once verified, immunization vials were retrieved from the portable cooler by the administering nurse in the presence of the nursing sister. Once verified, the nurse would then educate the parent on the immunization to be administered and any other pertinent information such as possible side effects and OTC medications if such effects occur. The nurse will then administer the drug in compliance with the universal drug administration guidelines. Once administered, the child’s documents were updated accordingly and advised on the date for the next visit (if any) in accordance with the immunization timeline. In addition, the serial or I.D number for all immunizations administered were recorded/ documented accordingly by the nurse and nursing sister. During this process, we were allowed to observe only. After completing all inhouse visits, we were then allowed to accompany Nurse McKenzie and Duncombe on a home visit within the community. When preparing for a home visit the necessary equipment (E.g., Sphygmomanometer) was secured. The home visit was specifically located in an area within Fox Hill named Springfield. The patient’s named was Mrs. Lloyd, a geriatric patient with a history of hypertension. The aim of the visit as stated by the nurse was a wellness check and to deliver the patient’s prescribed medication. While there, we were introduced to both the patient and her grand daughter who were both at home at the time. It was also established by the nurse that a nursing student within our group would be conducting a family case study on her and her family over the next several weeks. Once rapport was established, we were invited inside, and the nurses then left. While inside the home of Mrs. Lloyd, myself along with two other nursing students asked open-ended and closed-ended questions. This allowed us to (1) get to know the patient better and (2) allow the patient to become more comfortable with sharing personal information. Once completed, the nursing student assigned to Mrs. Lloyd arranged for follow-up visits and we left.
To identify, select and familiarize myself with a family/ person of focus for a family case study
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To make contact with the family selected for a family case study and arrange for follow up visits.
Apart from being able to observe and participate in a home visit, I was not able to participate in a personal home visit of the person selected for me with regards to the family case study. The patient selected for me was unavailable at the time of scheduled clinical hours. As a result, I was asked to leave my name and number to which an introductory visit would be scheduled the upcoming Friday. However, I was still able to gather basic information about my patient. My patient’s name is Ms. Essie Ferguson, an 82-year-old retired female who resides on Rahming Street. She is also a known diabetic and hypertensive patient.
However, On January 20th, 2023, I was contacted by Nurse McKenzie. It was requested of me to come to the Fox Hill clinic so that Nurse McKenzie can accompany me to the home of Ms. Essie Ferguson. Upon arrival to the home, I was able to briefly introduce myself to the patient and her two daughters. While there, I informed the patient along with her daughters of the reason for my visit and ask for permission to arrange for follow up visits during clinical hours.
Evaluation
As a result of my first clinical rotation, all (5) of my objectives chosen were met with satisfactory outcomes.
Special Considerations
Given the opportunity, I would have conducted a basic health assessment/ screening (Blood Pressure Check) on the patient within the first home visit (Mrs. Lloyd). Even though being compliant with hypersensitive medication is important, I do believe that frequent screening for patients with chronic conditions are vital. This will also monitor the patient’s response to treatment.
