Combined Portion.doc.docx



Part I. Project DetailsProject title:Brownsville Disease-Prevention and Health-Promotion Parenting WorkshopsNames and Responsibilities of Group Members: 1. Team Leader: Damion Mark2. Team members: Olga Andrianova: Parenting workshop on asthma prevention, identification and treatment; Part II Description of the community assessment sections B & C; Part V Planning and implementation, sections A, B & C; powerpoint synthesis. Abdul Haq: Parenting workshop on diabetes-prevention; Part III Areas of assessment, section A, sub-sections 1-3, section B; compilation of project paper.Kenn Vincent Kongyingyong: Parenting workshop on asthma prevention, identification and treatment; Part V Planning and implementation, section E. May O. Lightfoot: Parenting workshop on diabetes-prevention; Part I Project details; Part III Areas of assessment, section A, sub-sections 4-6; Part V Planning and implementation, section F; collation of project binders. Damion Mark: Parenting workshop on preventative health strategies; Part II Description of the community assessment, section A; Part III Areas of assessment, section C; Part V Planning and implementation, section D; team leadership responsibilities. Marie Pierre: Parenting workshop on preventative health strategies; Part VI Evaluation, sections A and B. Li Xie: Parenting workshop on asthma prevention, identification and treatment; Part IV Application: diagnostic community statements, sections A and B. Dates and times of data collection:Data collection of enrolled FirstSteps students, their parents and caregivers took place over various days, primarily on Tuesdays from 8:30am - 12:30pm starting in August 26, 2014 through December 2, 2014. Additional Brownsville community data was collected through individual team member efforts throughout the Fall 2014 semester. Sources of Assessment information:American Diabetes Association. (2013, December 16). Blood Glucose Control and ExerciseRetrieved from American Nurses Association. (2008). Scope and standards of nursing informatics practice.Washington, D.C.Arnold, E., & Boggs, K. U. (2011). Interpersonal relationships: Professional communication skills for nurses. St. Louis, MO: Elsevier/Saunders. Brookdale University Hospital & Medical Center. (2013). Brookdale Hospital - Brookdale Urgent Care. Retrieved November 24, 2014, from Brookdale University Hospital & Medical Center. (2013). Brookdale Hospital – MedicalDepartments & Services. Retrieved November 24, 2014, from Brookdale University Hospital & Medical Center. (2013). Brookdale Hospital - SchlangPavilion. Retrieved November 24, 2014, from Brooklyn Perinatal Network, Inc. (2014, April). Brownsville & East New York Healthy EatingFree Active Living Community Resources. Retrieved November 17, 2014, from Public Library. (2014). Brownsville Library - Community Directory. Brooklyn PublicLibrary. Retrieved October 27, 2014, from Multi-Service Family Health Centers. (2014). About Us. Retrieved October 27, 2014, from for Disease Control and Prevention.(2014) The Flu Season. Retrieved Nov 19, 2014 from for Disease Control and Prevention. (2012). Healthy weight - it’s not a diet, it’s a lifestyle! Retrieved from for Disease Control and Prevention. (2012). Allergy testing for persons with asthma [Data file]. Retrieved from for Disease Control and Prevention. (2012). Asthma’s impact on the nation [Data file].Retrived from for Disease Control and Prevention. (2014, June 19). CDC - Lead - Prevention Tips.Retrieved November 30, 2014, from for Disease Control and Prevention. (2014, Oct 22). Misconceptions about Seasonal Fluand Flu Vaccines Retrieved Nov 19, 2014 from for Disease Control and Prevention. (2011). National Center for Health Interview Survey. Retrieved from for Disease Control and Prevention. (2014, Aug 19). Vaccine Information Statements. Retrieved Nov 19, 2014 from Services. (2014). The Brownsville Partnership | Community Solutions. RetrievedNovember 30, 2014, from Department of Health. (2014). Flu Self-Care Guide Retrieved Nov 19, 2014 from, L. A. (2014). NUR 4010 Section HD22 (2615) Community Health Nursing [Syllabus].Department of Nursing, New York City College of Technology, Brooklyn, NY.Fiese, B. & Schwartz, M. (2008). Reclaiming the family table: Mealtimes and child health and wellbeing. Social Policy Report, Volume XXII (Number IV). Retrieved from School of Public Health. (2014). Simple Steps to Preventing Diabetes. Retrieved from, S. P., & Klainberg, M. B. (2014). Community health nursing: An alliance for health.Burlington, MA: Jones & Bartlett Learning.Lowenstein, K. (n.d). Asthma and Allergies What's the Connection. Retrieved November 29, 2014, from Mayo Clinic. (2012, May 17). Low hemoglobin count When to see a doctor - Symptoms - MayoClinic. Retrieved November 30, 2014, from McCance, K. & Huether, S. (2006). Pathophysiology: The biologic basis for disease in adultsand children. St. Louis: Elsevier Mosby. National Diabetes Education Program. (2013, February 1). Get Real! You Don't Have to Knock Yourself Out to Prevent Diabetes. Retrieved from York City College of Technology Department of Nursing. (2014). Baccalaureate Program Nursing Student Handbook. Retrieved November 30, 2014, from York City Department of City Planning. (2012). 2010 and 2000 census redistricting files [Data file]. Retrieved from York City Department of City Planning. (2014). Community Portal: Brooklyn CommunityDistrict 16. Retrieved from York City Department of City Planning. (2014). DP02: Selected social characteristics[data file]. Retrieved from York City Department of City Planning. (2014). DP04: Selected housing characteristics[data file]. Retrieved from York City Department of City Planning. (2014). DP05: ACS demographic and housingestimates [data file]. Retrieved from York City Department of City Planning. (2012). New York City neighborhood tabulation areas, 2010 [data file]. Retrieved from York City Department of Health and Mental Hygiene. (2013). Epi data brief, No. 28: Diabetes-related mortality in New York City. Retrieved from York City Department of Health and Mental Hygiene. (2013). Community HealthSurvey 2012. Retrieved November 24th, 2014 from York City Department of Health and Mental Hygiene, Bureau of Vital Statistics. (2010). Summary of vital statistics 2009: The city of New York. Retrieved from York City Department of Health and Mental Hygiene. (2014). Summary of vital statistics 2012 the city of New York mortality [Data file]. Retrieved from New York City Department of Parks & Recreation. (n.d.). Howard Playground : NYC Parks. Retrieved from York City Housing Authority. (2014). NYCHA property directory block and lot guide[data file]. Retrieved from of Disease Prevention and Health Promotion. (2014). Introducing healthy people 2020 [Data file]. Retrieved from J. Cooper Center for Human Services, Inc. (2014). PROGRAMS | Paul J. Cooper. Retrieved from Powell, S. K., & Tahan, H. A. (2010). Case management: A practical guide for education andpractice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.SCO Family of Services. (2014). FirstStepNYC Early Education Leadership Institute. Retrieved November 30, 2014, from Sutter Health (2013). Child asthma action plan [Data file] . Retrieved from Brooklyn Reader. (2014). Making Brownsville the healthiest neighborhood in NYC [Data [Data file] retrieved from Center for the Study of Brooklyn. (2012). Brooklyn neighborhood reports 2012. Retrieved from Regional Health Authority (2007). Using a peak flow meter [Data file] . Retrieved from, B., Fishman, P., & Lin, E. H. (2014). Role of the Nurse in Chronic Illness Management: Making Medical Home More Effective. Nursing Economics, 32(4), 178-184.U.S. Census Bureau. (2011). New York City community districts, 1990 to 2010 [data file]. Retrieved from . S. Census Bureau, (2011). DP-1- Profile of general population and housing characteristics: 2010. 2010 Demographic Profile Data. Retrieved from. Census Bureau, (2013). S1901 - Income in the past 12 months (in 2012 inflation-adjusted dollars). 2008-2012 American Community Survey. Retrieved November24th, 2014 from .xhtml?src=CFU.S. Department of Veterans Affairs. (Sept, 2014). Home Care Guide for Flu. Retrieved Nov 19, 2014 from . Department of Veterans Affairs. (2014) Self assessment tools. Retrieved Nov 19, 2014 from Department of Health (2010) . Asthma action plan [Data file]. Retrieved from II. Description of the Community Assessment. A. Use Census Tract or other statistical resources to determine boundaries of the community.Brownsville is the economically challenged residential community located in east Brooklyn. According to census data 2010, it has the highest concentration of public housing in the city, with almost sixty thousands people living literally on top of one another. The population is mostly African American and Hispanic (“2010 and 2000 census”, 2012). The area is accessible on the 2, 3, and L New York Subway lines. B. Summary statements/paragraphs of the community.Brownsville has been known throughout the years for its crime gangs, endless robberies and shooting. Even though the crime rates significantly lowered, the neighborhood is still called the “murder capital” of New York (“Making Brownsville,” 2014), making it one of the most dangerous areas in Brooklyn. Due to the high crime rates, the large percent of male population of the community is either in prison or killed, leaving many families with single parents, who live at or below the poverty line. The number of families entering homeless shelters is one of the highest if compared to the rest of Brooklyn. Besides the poverty and high crime stressors that the community struggles with, there are many health concerns that need to be addressed. The tremendously high rates of obesity, diabetes, asthma, heart disease, cigarette smoking, and the death rates from all causes shows the lack of community’s control over its health destiny. Despite of the obvious need of health support, health promotion and education, the Brownsville lacks of health clinics and hospitals. Besides, Brownsville has very limited number of parks, recreational areas, and green spaces, which creates an additional risk for health of the members of the community. C. Supplemental data (photos, other material)Part III. Areas of AssessmentA.Focus on Community-Based Needs1. Patterns of Morbidity and MortalityBrownsville is a community in Brooklyn that bears the burden of dire health statistics which clearly illustrate, with the starkest relief, the significant health disparities that exist among the New York neighborhoods. According to the Bureau of Vital Statistics (2009) of the New York City Department of Health and Mental Hygiene, the Brownsville community district (CD 16) had the highest crude death rate due to homicide at 22.3 per 100,000 population. This neighborhood also has the tragic distinction of also ranking highest among all of the NYC community districts in the Infant Mortality Rate (IMR), with 11.3 deaths per 1,000 live births in 2009. Overall in 2009, CD 16 was in the highest quintile of death rates per 100,000 population for age-adjusted death rate, heart disease, malignant neoplasms and diabetes mellitus. It also ranks among the highest rates in the NYC community districts in death rates for HIV disease, chronic liver disease and cirrhosis, and mental disorders due to substance use and accidental poisoning. In other health and birth measures, this community continues to struggle. In 2009, it was in the second highest quintile of births to unmarried women, at 81.2%. Brownsville also was ranked highest in percentile of pre-pregnancy obesity rates, at 30.5%. (NYC Department of Health and Mental Hygiene). Altogether in 2009, the Brownsville community district ranked among the highest, if not the highest of in 10 out of 16 dire health measures across the NYC community districts. Not only do these statistics speak reams about the health struggles of the community at present, but in looking at the percentile rates of births to unmarried women as well as pre-pregnancy obesity rates, the struggles of community health seem to be projected in the future, due to the impact of perinatal factors on children’s future health. These community health patterns are unusual in the sense that they are so dire as compared to other NYC communities such as Bayside, Queens, which compared to CD 16’s age-adjusted death rate of 8.3, with a rate of less than half of that, at 3.7. These health measures are tragically consistently elevated within the community, across so many poor health measures. (NYC Department of Health and Mental Hygiene, 2009). 2. DemographicsAccording to the 2000 and 2010 U.S. Census Bureau redistricting files, the Neighborhood Tabulation Area (NTA) reports Brownsville to have a population of 58,300 in 2010, which is a decrease of 1.4% from 2000, where the population was listed as 59,099. Further synthesis of census data was processed via community district, of which Brownsville belongs to CD 16. According to New York City Department of City Planning (2014), CD 16 envelops three neighborhoods: Broadway Junction, Ocean Hill and Brownsville. This community district covers 1.9 square miles, of which the distinct boundaries of Brownsville complete 1.163 square miles, dominating that community district. The statistical descriptive demographic data to follow is to be understood to represent the community district 16, through which a picture of an approximation of Brownsville can be deduced, but not assumed to be exact. Brownsville is a community with a majority female population of 57.5%, where the median age of a resident is 30 years old. The vast majority of the residents in Brownsville (98.7%) identify as being of one race, and of them, about 80% identify as black or African American, with the remaining approximation of the community identifying, for the most part, as Hispanic or Latino. (U.S. Census Bureau, 2010)In terms of educational attainment, Brownsville residents have low population percentages. Of those 25 years or older, 17.1% have achieved some level of high school education, though without attaining a diploma, and 10.3% have less than a 9th grade education level, with only 36.8% having graduated high school with a diploma. Only 7.8% of this segment of the population has attained a bachelor’s degree. According to the NYC Department of City Planning, in 2014, CD 16 has a total of 50.5% of the population receiving public income support of some kind (cash assistance, supplemental security income or medicaid) which is a decrease of 1% from 2005. Of the housing provided to this community, it is dominated by public or subsidized housing, which constitutes 68.5% (Brooklyn Neighborhood Reports, 2012). Much of this housing is made up of 18 NYC Housing Authority buildings (NYCHA) (New York City Housing Authority, 2014). There have been some significant population changes between 2000 and the most recent census of 2010. The residents are aging, with an increase of 25.9% of the households housing one or more persons 65 years and older, which reflects a nationwide shift. There has also been a significant increase in the population of 12.9% of those who identify as of Hispanic origin since the 2000 Census count, pointing to a shift in the community identity. (U.S. Census Bureau, 2010)3. Environmental ConcernsBrownsville is a dense, urban community. Percentage-wise, the lot-usage area captures the portrait of the landscape. 36.4% of the land area is for multi-family residential use, characterized predominantly by NYCHA brick housing units. Open space/recreational space comprises 5.4% of the lot area, which is closely rivaled by 4.6% vacant land and 4.8% industrial space. 22.4% of the land is 1-2 family residential housing, and the remaining 26.4% of the land is divided between institutions, mixed residential/commercial space, transportation or parking use. (New York City Department of City Planning, 2014)Given the dense industrial and urban nature of Brownsville, the environment may pose a potentially negative health risk to the community. With minimal green space, the residents have limited recreational access in the outdoors, which may limit their access to no-cost exercise such as walking, jogging or sports-playing activities. Since this is a resource-challenged community, with many health challenges, there is a great need for low or no-cost resources to enable and promote accessible exercise. Additionally, with such an elevated homicide rate, and the community’s well-founded perceptions of itself as an unsafe environment, these aspects may reinforce the residents reluctance to exercise in the local outdoors, therefore increasing that obstacle to improving health. As the city’s statistics indicate, Brownsville is a dense, partially industrial neighborhood signifying that the high-traffic nature of such an area tends to produce a high degree of air pollutants, resulting in poor air quality. This potentially compromised air quality may impact the residents respiratory health and could leading to such illnesses as asthma, COPD and chronic respiratory infections.Public servicesEmergency ServicesBrownsville, Brooklyn has various public services to serve the community needs of its residents. These services include emergency services such as from the Police Department at the 73rd Police Precinct on 1470 East New York Ave with telephone number 718-495-5411 and the Fire Department services at Engine 233, Ladder 176 on 107 Watkins St with telephone number 718-965-8231. The post office serving Brownsville is located at 167 Bristol Street with telephone number 718-346-1988 and the sanitation department is Brooklyn North #5 at 606 Milford St with telephone number 718-649-3074 (Brooklyn Public Library, 2014).Educational ServicesThere are also several educational facilities in Brownsville such as Public schools, Private schools, and daycares. The public schools include P.S. 12 at 430 Howard Avenue, P.S. 298 at 85 Watkins Street, P.S. 178 at 2163 Dean Street, P.S. 327 111 Bristol Street, P.S. 322 51 Christopher Street, P.S. 282 at 220 Watkins Street, and I.S. 55 at 2021 Bergen Street. The private schools located in Brownsville are Bethany Christian Grade School at 521 Thomas S. Boyland Street, People's Christian Day School at 121 Riverdale Avenue, ENY-A Community School on 345 Thatford Avenue, and Risen Christ Lutheran School at 250 Blake Avenue. The Daycares include Amboy Street D.C.C. At 217 Amboy Street, Faith, Hope Charity at 772 Saratoga Avenue, Brownsville Child Care Center at 1592 East New York Avenue, and Nat Azarow Day Care Center. Community FacilitiesCommunity Board No 16 located at 444 Thomas S. Boyland Street, Room 103, is the Community Board that serves Brownsville and also Ocean Hill. It is run by organizational leaders such as the chair, Bettie M. Kollock-Wallace and the district manager, Viola D. Greene-Walker. Residents interested in affairs in the community could attend the Board Meetings the 4th Tuesday of every month at 7:00 pm and Cabinet Meetings the 2nd Wednesday of every month at 9:30 am. Recreational Facilities Howard Houses Park & Pool are one of the parks in Brownsville located at Mother Gaston Boulevard and Glenmore Avenue, which has basketball courts, outdoor pools, spray showers, handball courts, and playgrounds ("Brownsville Library - Community Directory | Brooklyn Public Library," n.d.). These recreational areas are ideal for young and old children alike and for parents to spend time with their children. Religious InstitutionsThere are various houses of worship serving people of various beliefs in the region such as Brownsville Church of God at 588 Saratoga Avenue, Faith Mission Church of God at 120 Glenmore Avenue, Christ Fellowship Worship Center at 400 Thatford Avenue, Faith Healing Temple Apostolic at 259 Sutter Avenue, and First Triumphant Church of Jesus Christ at 1528 Pitkin Avenue. Special Yearly Events There are special events throughout the year to engage citizens at Brownsville to be more involved in their community such as the 5 Kilometer Run & Walk-a- Thon in June, the Watkins Street Block Association Festival in August, and Brownsville Day in May.AestheticsThe Howard Houses Park & Pool on Mother Gaston Boulevard at Glenmore Avenue and East New York Avenue is a nice park with several trees and a jungle gym. Other parks that are also aesthetically attractive include but are not limited to Betsy Head Park on Blake Ave., Dumont Ave., Livonia Ave. Between Strauss St., Hopkinson Avenue and Bristol Street, Carter G. Woodson Children's Park on Sutter Avenue and Belmont Avenue, and City Line Park at Foundatin Avenue & South Conduit Avenue (Brooklyn Perinatal Network, Inc, 2014, p. 11). If families at Brownsville, NY want to take a walk in a nice area, this park would be the ideal place in the area to be.Health-related facilitiesThere are facilities in Brownsville that provide health care services for its residents such as Brownsville Multi Service Family Health Center on 592 Rockaway Avenue, Paul J. Cooper Center for Human Services on 106 New Lots Avenue, East New York Child Health at 1620 East New York Avenue, and Brookdale Hospital on One Brookdale Plaza, Brooklyn, NY 11212. Brownsville Multi Service Family Health Center is a Federally Qualified Health Center that provides health care to people with or without the ability to pay for medical care. This facility operates out of 10 services sites throughout Brownsville, has the golden standard seal of approval for quality provision of care: the Joint Commission Accredited medical practice status, and is a Patient Centered Medical Home Level 3 that helps to provide strong patient outcomes. All these components of this facility collectively function to provide high quality and cost effective care to its clients ("Brownsville Library - Community Directory | Brooklyn Public Library," n.d.). In terms of the services it provides, Brownsville Multi Service Family Health Center provides medical care services in Adult Internal Medicine, Infectious Diseases, Pediatrics, OB/GYN, Dentistry, Psychology, Psychiatry, Social Services, Medical Records, Brownsville Community Pharmacy, Dermatology, Optometry, Podiatry, Nephrology, Nutritional Counseling, Physical Therapy, Surgery Consultations, and Wellness Programs (Brownsville MultiService Family Health Centers, 2014).The Paul J. Cooper Center for Human Services also provides health care services to the residents in Brownsville. These services are provided through the Mental Health Clinic of Paul J. Cooper, the Paul J. Cooper Chemical Dependency program, the Paul J. Cooper Residential Services, and the Paul J. Cooper Medicaid Service Coordination (MSC) Department. The Mental Health Clinic of Paul J. Cooper located in Crown Heights, Brooklyn, licensed by the New York State Office of Mental Health, provides mental health services to its clients. This center emphasizes certain aspects of its patients, such as the strengths of the patients and their families, the role of cultural diversity in its clients, and the role of the case management model in delivering high quality and cost effective care to its patients (Paul J. Cooper Center for Human Services, Inc., 2014). The Paul J. Cooper Residential Services on the other hand provides shelter and other services to clients with mental retardation and developmental disabilities that require 24 hour direct care support. And the Paul J. Cooper Medicaid Service Coordination (MSC) Department helps to provide supportive services to clients with special needs. Brookdale HospitalBrookdale Hospital is a major tertiary medical center that offers a variety of medical services such as Ambulatory Specialty Services, Family Care Services, Pain Management Services, Cancer treatment, Pediatric services, Women's health services, HIV/AIDs services, Bariatric Surgical services, and behavioral healthcare services (Brookdale University Hospital & Medical Center, 2013). The Brookdale Urgent Care Center is open Mondays to Sundays from 10:00 am – 10:00 pm and provides efficient medical care to community residents on an unscheduled and walk in basis (Brookdale University Hospital & Medical Center, 2013). The Urgent Care Center provides pediatric and adult care by physicians and nurse practitioners, on-site retail pharmacy services for Urgent Care patients, and full service digital diagnostic x-ray radiology services (Brookdale University Hospital & Medical Center, 2013). This center should be utilized for illneses and injuries that require prompt medical attention, but are not life threatening.The Arlene and David Schlang Pavilion is a senior citizen housing located on 560 Rockaway Parkway Brooklyn, NY 11212, that provides care for residents in Brownsville that are able to live independence, but require Assisted Living Services. This pavilion provides a certified home healthcare program, a 448 bed nursing home, various primary care cites, outpatient and outreach services, a geriatric mental health program, and a kosher "Meals on Wheels" (Brookdale University Hospital & Medical Center, 2013). The Department of Housing and Urban Development (HUD) provided financial support for the construction of the Pavilion and is located on Rockaway Parkway between Linden Boulevard and Church Avenue (Brookdale University Hospital & Medical Center, 2013). Services that the Assisted Living units provide include Case management, personal care, nursing care, home health services, physical therapy, occupational, therapy, and respiratory therapy, speech therapy and audiology services, homemaking and food services, and medical supervision (Brookdale University Hospital & Medical Center, 2013).B. Care management techniquesAccording to the Case Management Society of America (CMSA), case management is a collaborative process of assessment, planning, facilitation, and advocacy to ultimately provide cost effective and high quality care to clients (Powell & Tahan, 2010, p. 4). Certain ways this is accomplished by Care Managers include improving patient satisfaction with health care delivered, providing client teaching on the nature of his disease, disease prevention and management topics, improving the collaboration among healthcare team members to improve client outcomes, advocating for the best interests of their clients, and improving the management of disease for their clients. However due to the rising rates of chronic diseases such as Diabetes Mellitus Type II and mortalities due to this condition among residents in Brownsville, Brooklyn, Case Managers should be more focused on the disease management task of Case Management. Disease management is an integral component of Care Management that focuses on helping to manage the care for clients in Brownsville with chronic diseases, such as diabetes mellitus type II. It should be understood though that the other aspects of Care Management are not independent of disease management, but instead incorporate some of the same aspects of care management such as utilizing the interdisciplinary team to help the client manage his disease and locating health care resources that will help prevent or treat certain diseases. The high prevalence and deaths rates due to diabetes in Brownsville, Brooklyn at "177/1000000" has made it a priority for Nursing Case Managers to provide disease management to reduce suffering by educating residents on methods of preventing diabetes (New York City Department of Health and Mental Hygiene, 2013, p. 2). This could be done by Case Managers educating residents in Brownsville through Community Health Fairs and workshops in Schools and Community events on methods of preventing diabetes such as by reducing their weight through the methods of eating healthily and engaging in more physical activity. Case Managers could educate the residents in Brownsville on the benefits of eating healthily to prevent diabetes such as by explaining the health benefits of eating 2-3 servings of whole grains a day to reduce the chances of developing type 2 diabetes by "30%," reducing the "83%" risk of developing diabetes by limiting the consumption of sugar-sweetened beverages, substituting trans fats found in food sources such as margarines, packaged baked goods and fried foods for polyunsaturated fats found in vegetable oils, nuts, and seeds (Harvard School of Public Health, 2014). Other health instructions that Care Managers could give to its clients to help prevent diabetes include substituting meat for proteins less in saturated fat such as nuts, whole grains, poultry, and fish, reducing the amount of time smoking, and reducing the consumption of alcohol (Harvard School of Public Health, 2014).The Care Manager could also help prevent diabetes in the residents of Brownsville by educating them on the need to engage in more physical activity. He should explain to the families in Brownsville that engaging in 30 monutes of physical activitiy 5 days per week could reduce the risk of developing Type II Diabetes Mellitus by 30 percent (Harvard School of Public Health, 2014). The Care Manager could encourage the residents to exercise in parks and recreational facilities that are found in Organizational websites and pamphlets such as the Brownsville & East New York Healthy Eating | Free Active Living Community Resources from the Brooklyn Perinatal Network, Inc. In addition to implementing teaching to reduce the rates and mortalities due to chronic diseases among individuals living in Brownsville, the Care Managers could also refer clients to essential health care services within the vicinity of Brownsville according to the medical needs of their patients. Such a facility that the Care Manager could refer the client to in order to receive health services is the Brownsville Multi Service Family Health Center, which provides health care to clients with or without health insurance.When the Care Managers refers the clients to various Health Care Resources around Brownsville such as Brookdale Hospital, a team base collaborative approach should be utilized to provide higher patient satisfaction, quality of life, and reduce total health care costs (Trehearne, Fishman, & Lin, 2014, p. 179). In this approach, a primary care delivery system emphasizes the importance of enhancing the long-term relationship between the patient and their care providers Trehearne, Fishman, & Lin, 2014, p. 179). So similarly, the Care manager could help the client to foster a relationship with his care provider whether through advocating to the care provider on the need for him or her to continue providing health services on and ongoing and long term basis or instructing the client on the importance of visiting the same health care professional. C. Influences on resource allocation decisionsCare Managers and Health Care Professionals should advise the Community Boards members and other Government organizations on the need to devote more resources on Primary and Preventative Health Care Clinics in Brownsville to improve the overall health of its residents. One reason for enhancing the delivering of financial resources towards Primary Prevention is prevalence of high diabetes related deaths on Brownsville, Brooklyn, which amounts to "177/1000000" (New York City Department of Health and Mental Hygiene, 2013, p. 2). The only hospital nearby this region: Brookdale Hospital on 1 Brookdale Plaza # L1, which is a 15 minute walk away from the community. Perhaps an urgent care or larger health care facility that contains a wide variety of health care services to serve the Primary, Secondary, and Tertiary needs of its clients should be established in Brownsville, Brooklyn. This would help to improve optimal health outcomes for its residents.There are several resources in the Brownsville community that have significant influences on in the neighborhood. For example, Housing Development Corporation (NEBHDCo) was incorporated in January 1985 as a 501c3 not profit organization, Their mission is the preservation, development and Mangement of affordable housing and homeownership opportunities; community and economic development initiatives and human services that effect social change in central Brooklyn. NEBHDCo provides services in four program areas: Affordable Housing, Property Management, Asset Management and Community Programs. Currently NEBHDC developed 2093 housing units of which 1082 are owned by the organization, and nearly 17,000 square feet of commercial space throughout the central Brooklyn neighborhood. The Community Programs Department works across four areas: Healthy Food and Living, Tenant Supports, Youth Supports and Social Activities. Programming includes:Healthy Food and Living: Golden Harvest food pantry; gardens; play streets; support for local healthy food businessesTenant Supports: Referral resources/public benefits supports; FTAP (Formal Trespass Affidavit Program); tenant meetings; winter coat driveYouth Supports: Youth aged out of foster care housing and supports; Finding Your Future educational scholarship; Hobby Quest camp program; Back to School supplies; holiday toy drive The Community Programs Department works across four areas: Healthy Food and Living, Tenant Supports, Youth Supports and Social Activities. Programming includes: Healthy Food and Living: Golden Harvest food pantry; gardens; play streets; support for local healthy food businessesTenant Supports: Referral resources/public benefits supports; FTAP (Formal Trespass Affidavit Program); tenant meetings; winter coat driveYouth Supports: Youth aged out of foster care housing and supports; Finding Your Future educational scholarship; Hobby Quest camp program; Back to School supplies; holiday toy drive Social Activities: Family and senior trips; Thanksgiving community meals. Other resource like Single Stop, are benefits and resources support agency, and has locations throughout New York City offering program services to low income families. All sites provide family support services, tax assistance and benefits counseling onsite legal and financial counseling services are available at specific sites. These resources positively affect the people of the Brownsville community. Other resources that influence the community are the 73 rd Precinct provide security & safety for community, the fire department; Engine 227 & Engine 231 which provides safety in the community. There is two Library in the neighborhood which provide valuable assistance to family educational needs, but improvement is much needed to broaden the availability of literature and the accessibility of computers at the library. In the neighborhood there are two libraries that provide valuable assistance to family educational needs, however, improvement is much needed to broaden the availability of literature and the accessibility to computers at the facilities. Several health care facilities such as Brownsville multi service family health center BMS @ Genesis/WIC Program, BMS ISIS @ Bristol Brookdale Hospital which serves this community but the over saturation of people over burden the resources at hand. The school resources is adequate in quantity, there charter schools that are significant to the Brownville for example, excellent boys charter, leadership prep Brownville, P.S 184. Emergency food centers are available at location for example, Brownville SDA Temple, New Life SDA church. Many churches provide assistance with food pantry to the community. The employment resources is lacking in the area. Also there is a lack of child care resource in the community. The lack of these resources may negatively impact growth and prosperity in the community. The Brownville community farmers Market support the community in providing fresh fruits & vegetables. The Brownville national association for mature people is the home for senior located in the heart of Brownville. Brownville recreation center is an award winning community recreation center, entails: pool, basketball court, dance classes rollerblading, computers, hand ball court, playground and more which provide a warm atmosphere for the people of Brownsville.Part IV. Application: Diagnostic Community StatementsA. Overall assessment of munity District # 16, which encompasses the neighborhoods of Ocean Hill and Brownsville, is located in central Brooklyn. It is comprised of 1188.5 acres of land and is bordered by Broadway on the north, Long Island Rail Road on the south, East 98th Street/Ralph Avenue, East N. Y. AVE, Ralph AVE, Atlantic AVE and Saratoga AVE to the west, and Van Sineren AVE on the east (New York City Department of City Planning, 2014). According to the 2010 census, there are 84500 residents living in Brownsville, and the majority are African Americans and Hispanics (U.S. Census Bureau, 2011). There are totally 33071 housing units, and 75.7% of them were built before 1970 (U.S. Census Bureau, 2013). Brownsville suffers with some of New York City’s highest poverty rates and unemployed rates. 34.1% of residents from Brownsville live in poverty, compared to 19.9% in New York City, and the median household income is $ 27901 (U. S. Census Bureau, 2013). 19.3% of residents in Bedford Stuyvesant/Crown Heights are not insured, and 24.6% of people have Medicaid (New York City Department of Health and Mental Hygiene, 2013). Obesity is a major health concern in this community. According to the NYC Community Health Survey 2012, in Bedford Stuyvesant/ Crown Heights, 29.3% of people are overweight but not obese and 27.4% of residents are obese (New York City Department of Health and Mental Hygiene, 2013)B. Diagnostic statement(s) with rationale and identified problems(s)Based on data from our assessment, we made three community nursing diagnoses related to three different health problems, and they are listed below:Imbalanced nutrition: more than body requirements related to limited options due to low socioeconomic status. People living in Brownsville have risk of diabetes. As evidence shows, most diabetes cases in the United States are type 2 diabetes, and it is highly related to obesity and physical inactivity. A large portion of people in Brownsville is living in poverty, and obesity is prevalent in this community. Due to the limited budget, they cannot afford healthy food such as vegetables and fruits because they are too expensive. Instead, they eat pizza and burgers. For people who are employed long hours, they are more likely to buy fast food after a long day of working because they are more convenient. Fast foods are usually highly processed and high in fat, calories, and sodium. Eating fast foods everyday will lead to weight gain and other health problems like high blood pressure and heart disease. In addition, people with low levels of socioeconomic status are more likely to be physically inactive. Violence is a big issue in poor neighborhoods like Brownsville, which may prevent people from going outside to exercise. Parks and sports facilities are also less available to people living in Brownsville, and people with low income cannot afford gym memberships and exercise equipment. Risk for obstructed airway related to air pollution as evidence by high smoking rate, over population, and poor housing conditions. Asthma affects millions of Americans, both young and old. According to the data from Centers for Disease Control and Prevention, there are estimated 25.9 million Americans affected by asthma, including 7.1 million children under 18 (2011). People living in Brownsville have high risk of asthma due to air pollution. Air pollution can be a potential trigger of asthma. Brownsville has the highest concentration of public housing developments in New York City. Over population and crowdedness in this community will cause increased outdoor air pollution. The heavily traveled roadways around Brownsville also produce a large amount of motor vehicle emissions, which contributes to outdoor air pollution. Smoking is another important risk factor for asthma attacks. According to the NYC Community Health Survey 2012, the smoking rate in Central Brooklyn is 16.1%, compared to 15.5% in New York City (New York City Department of Health and Mental Hygiene, 2013). Substances from smoke will irritate the airway to secrete more mucus, triggering attacks in a person who has asthma. Furthermore, some housing conditions are associated with asthma triggers. For example, dust mites and cockroaches infestations produce airborne allergens, which may cause asthma to people who are highly sensitive to those substances. According to the NYC Community Health Survey 2012, 32.3% of people from Bedford Stuyvesant/ Crown Heights area saw cockroaches at home in the past month (New York City Department of Health and Mental Hygiene, 2013). Most of the housing units in Brownsville were built before 1970, and old buildings are more likely to have pest infestation. In addition, poor neighborhoods like Brownsville may have more poor housing conditions related to asthma triggers compared to other richer neighborhoods due to lack of building maintenance. Knowledge deficit related to lack of information about immunization as evidence by low flu shot and pneumococcal vaccination rates and expressing concerns about side effects and safety of vaccine. Immunization is the process by which an individual becomes resistant to a specific infectious disease, mostly by administrating vaccines. Vaccination is an effective way to prevent diseases. Thanks to vaccines, a lot of fatal diseases have been delimitated in the United States. Newborn babies are immune to many diseases because they carry antibodies from their mothers. However, after one year, when those antibodies from mothers are gradually gone, young children are at risk for many fatal diseases because their immune systems are still not mature enough. On the other hand, as people get older, their immune systems get weaker over time, which puts older adults at higher risk for certain diseases. So it is very important for young children and older adults to get vaccines. Unfortunately, according to the NYC Community Survey 2012, for adults more than 50 years old living in Central Brooklyn, the flu shot rates and pneumococcal vaccination rates are 53.3% and 39.9% respectively (New York City Department of Health and Mental Hygiene, 2013). Myths and misinformation about safety of vaccines can be a major reason that prevents people from vaccination. During our assessment, a lot of parents at FirstStepNYC expressed concerns about the safety and side effects of vaccines. It indicates the need for further education about vaccination. Like any other health interventions, vaccine may cause side effects, but most side effects are mild and will go away quickly. By working closely with health care providers, we can minimize the side effects of vaccines. Part V: Planning and implementation:Part VA. Goals and/or objectives of project. The main goal that we had set for our community project was to create the awareness and understanding of the existing health problems, such as diabetes, obesity, and asthma, which affected the community. Because the FirstStepsNYC is oriented on Pre-K children, our group also set the goal to deliver the information on preventative health strategies, such as immunizations, well doctor and dental visits, that parents can follow in order to promote growth and development of their children. In addition to promotion of health knowledge, our group intended to screen the children at Brownsville FirstStepsNYC program on the risk of obesity, measuring their BMI. B. Data, site, and address where project took place.The community project took place from 10/09/2014 till 12/09/2014 at one of the FirstStepsNYC locations, at PS/IS 41, a K-8 elementary and middle school in Brownsville, 225 NewPort Street, Brooklyn, NY. C. Number of community participants/clients attending.The FirstStepsNYC at PS/IS 41 includes 97 kids from 89 families. Our group tried to reach all of the adult members of the program in order to invite them for the workshops. 13 parents participated in the first workshop, and 20 parents participated in the second. Considering that each parent represented one family, we can tell that our group reached 14.6-22.5 percent of the FirstStepsNYC Brownsville community. D. Community organization that provided assistance with project.1 & 2. List of community organizations and type of assistance provided by organizations.a. Downstate pediatrics: The department of pediatrics at SUNY Downstate Medical Center offers a full range of services for children and adolescents in both general pediatrics and various subspecialties. Well child care including guidance for immunizations for infants and school checkups, constitutes part of their medicine, child development and development disabilities, critical care cardiology, neonatology, pulmonary diseases, gastroenterology, hematology/oncology, nephrology, endocrinology, allergy and acute and chronic pediatric care. All of the physicians in the department are board certified. Downstate pediatrics also collaborates with SCO Fist Steps by referring children who have special health needs and/ or who may benefit from a development evaluation to your program. Downstate Pediatrics may refer families with infants, toddlers and/ or preschoolers including children with special needs, to apply to FirstStep’s Center and Home base Early Childhood program. b. Infant and Child Learning Center: The Infant and Child Learning Center provides a comprehensive program to children from birth to Five years of age. The ICLC trained staff, works in partnership with the parents in order to achieve the best possible outcome of their child’s continuing development. They provide early intervention preschool special education services for children with a disability with a variety of medical condition including: premature birth, neurological impairment, congenital anomalies, orthopedic impairment and HIV Infection. These services are provided at no cost to the parents. c. Achieve Beyond; Pediatric Therapy & Autism Services: Provide training support and Therapeutic evaluation and services to children across New York State regardless of their ethnicity, socioeconomic level, or religion. Achieve Beyond’S Mission is to deliver evaluations and therapeutic/education services using a family centered and multilingual approach to ensure children’s development needs are met in nurturing , appropriate, and supportive environment . Also they provide services in a multitude of languages to Autism and special education for Children from birth - 21 years of age, speech therapy, occupational therapy, physical therapy, social work, feeding therapy, parent training and free works for parents and staff.d. Healthy Smiles: Is an innovative leader in children’s dental care. It is the only non-hospital based outreach dental program recognized and contracted by New York State Medicaid funded Insurance program. Healthy Smiles travel to preschools and day care centers throughout New York City with the main goal of making oral healthcare accessible to every child. They provide services in oral hygiene workshop which includes instruction on how to maintain clean and healthy teeth, examination, gentle cleaning and fluoride treatment. The services are non-invasive and done within the school under the supervision of the school staff. The children are sent home with a report explaining the status of the children’s teeth and whether the child needs a follow up visit with their primary dentist. e. GED Program at P.S 184: They may refer families with infants and toddlers and pregnant women to apply to the program. Also they may refer families with infants & toddlers and pregnant women to apply to the program which provide education training in Mathematics, English and Sciences. f. Brooklyn Perinatal Network, INC. It’s a two year community collaborative project funded by the NYS Health Foundation which addresses Fragmentation of care, a key social determinant of health, in order to improve birth outcome in north Central Brooklyn. By the merging of health information technology tools and expanding access of these tools to social and medical support services, care coordination will enhances , comprehensive and fluid by bridging the gap between the medical and psycho-social needs of the clients. It helps to improve health outcome of pregnant and parenting women in Brownsville area.g. Baby Buggy: They families with infants and toddlers with toys, clothes, shoes and also make donation in special baby and children equipments.E. Implementation:1. Implementation of ProjectOur service-learning project at PS41: First Steps centered around three main topics that we believe are important for this population. The three main topics are: Flu Vaccination, Diabetes prevention, and Asthma. Each topic was discussed separately and with different techniques that would keep the parents interested. Each presentation had students who lead the presentation and guided the other students in to what they have to do during the presentation. Two weeks prior to the presentation, informing the parents about the upcoming event was the priority. Utilizing different resources at PS41: First steps, there was a good turn out for each presentation.We also conducted other health related activities at PS41: First Steps. Home visit, children health screening, and working along side teachers. Two of our student had the opportunity to partake on home visit. They interviewed the parents, assessing their health, the family’s wellness, and the family’s strong and weak points. Children at the center were measured for their height, weight, and BMI. The numbers were recorded and placed on each child’s chart. After reviewing over the result of the measurements, we conducted an interview with the parents. Here we would have the opportunity to educate them about their child’s risk, modification that they can make to their lifestyle, and what to expect from the decisions that they will make. Assisting the teachers and various instructors was also a part of our duty at First Steps. We assisted them with feeding the children, with various activities that took place, and ensuring that children are safe while they are at the playground. 2. Publicity:In order for us to allure parents to coming to each service learning project, we decided the best way of gaining publicity is to address them personally when they drop of their children. Providing them with a sneak peak as to what topic the presentation will be on and a flyer was our way of giving them information when and where it will take place. The helpful staff of PS41 also handed out the flyers through out the days that we were not at the site. The first service-learning project served as our launch pad in creating a rapport with some of the family members that joined us. We had a good turn out for our first presentation; afterwards we mentioned that we are having two more presentation where we are going to be presenting the remaining two topics.3. Presentations:Flu vaccination presentation:The Flu vaccination presentation was our first service-learning project at PS41: First Steps. The two students who took upon the lead decided that the best way of conducting the presentation is by doing an open table discussion, where parents were able to ask questions freely as topics are brought up for discussion. In the discussion, parents were provided with packets that contained information about Flu vaccination, the myths, the benefits, and as to where in their neighborhood they can obtain vaccination. With the presentation being an open table discussion, parents brought up questions they had about the flu vaccine. Either the students or the professor answered the question, and other parents were able to voice out their opinion.Diabetes prevention presentation:The Diabetes prevention presentation was the second service-learning project at PS41: First Steps. The two lead students conducted the presentation with a lecture style as well as a question and answer portion after each topic was presented. The students also prepared different props in order for the parents to have a visual of what is being presented. The parents were given a packet containing valuable information about diabetes and a form which they can fill out and see if they are at risk for diabetes or not. The presentation contained the risk factors, what parents can do to keep the children active, better food choices, and what can they do to lessen the risk of getting diabetes.Asthma presentation:The final service-learning project we had in First Steps centered on Asthma. The presentation was conducted with the utilization of a round table discussion/ lecture. In this service-learning project, materials were handed out that contained different information about asthma and different resources that they can utilize. We wanted to see as to what level of understanding the parents have about asthma, so we would open up the table with a question and hear the parent’s answers. After the presentation, a demonstration on how to use a peak-flow meter and what the stoplight template entails for someone who has asthma took place. Here we would explain the importance of partaking in using the peak-flow meter. If the parents have other questions, they were address accordingly.4. Advertisements:Our main sources of advertising each service-learning project were flyers and word of mouth of the teachers. We made sure that our flyers were prepared two weeks ahead of the presentation. We informed the head of the program about our presentation and she ensured that it was mentioned to all the staff in the center and to pass the message to the parents of the kids. I attached the three flyers that we usedF. Cost of ProjectThe bulk of the project-costs were surrounding creating literature that could be circulated among, and provided to the clients containing educational and informative material. These cost were elevated depending upon the nature of the literature: higher costs were for more colorful, attractive literature to facilitate a more engaging product; lower costs for black and white printing. Funds were needed for photographic documentation of attendance and appearance of the implementation of the project workshops. Costs were found in required materials such as paper, printer ink, professional printing at office-supply stores and material needed for advertising for signage such as lettering and poster-boards. Additional costs were from creating tangible compilations of the community project work such as binders, plastic page protectors and section dividers. There were also costs in creating comfortable, pleasurable and healthful enticements to joining and enjoying the parenting workshops such as snacks of bell peppers, hummus, coffee, apples, and the accompanying paper products to facilitate eating such as napkins, cups and plates. There were funds required to purchase demonstration items such as healthy alternatives to “junk foods” by buying the comparison items such as: cereals, juice, seltzer and sugar packets. Altogether, financial needs cropped up throughout the production and implementation of the community service learning project to solicit attention and to facilitate a meaningful, rich and enjoyable experience for the clients of the community. Part VI: EvaluationGoals accomplishmentDescribe goals you wanted to accomplishHere at FirstStepNYC our main goal accomplished was delivering adequate health information on preventive care. We strive to empower the community into making informed decision in regards to their healthy which was done by workshops. Empowering is significant because it provides the community the opportunity to succeed by becoming participant in their care. Another one of our main focus during the workshops was teaching. We wanted to create a culture of healthy lifestyle in the long term aspect of wellness. We try to incorporate a positive attitude and mindset towards consistent behavior while at FirstStepNYC. However, the goals and planning depends on the community needs. The Brownsville area has high prevalence for developing type 2 diabetes. We want to decrease those chances for those at high risk especially the children we encountered here. This objective is to work towards making effective change that will be long-term. As for this semester we want to raise awareness in the community and provide teaching. We want to build trust with people in the community being that the program is new in order to examine if the community is receptive to it. We want to exhibit compassionate, excellent service to families. We want the parents to feel accepted, welcome, while treating them with respect and integrity according to ANA standards. As a short term goal we want to invest in the community our knowledge so that they can take control of their health. We want to encourage the community to be self-motivated, creative, and independent in their actions to a healthy quality lifestyle. At the end of this, we want families to begin being health conscience in making healthy decisions that will benefit them in the long-term. We want to educate the community about resources allocation and how to access those resources. We want to see the community get excited about their eating habit even with the low socio-economic state that they are in. We want the participant to spread the information to those who cannot attend the workshops. We would love to see the community advocate for themselves and on behalf of others who do not have the chance to participate. Also to invite others to participate and bring creative ideas for future meetings and workshops. So they can strive to wellness.?2. Describe the collaborative process of goal settingThe collaboration process involve the community and the client’s voice. The professor is a great tool to us having gather data about the community which is a good source of information that help students going into the unknown. Asking parents about their goals for their children and their expectations for the future. Also their concerns and the role that they can play in assisting their child accomplish that goal. The staff directors are great assets for the student as they orient us about the policy and procedure at FirstStepNYC. Understanding the mission and vision of the facility will help the collaborative process to be effective when we all are on the same page. As facilitators we are here for the parents and let them know how we can be a change agent fostering that approach in a positive way using evidence based research. The school teacher’s input are welcome because they deal with the kids on a regular day to day basis. The program has volunteer that offer their services and they are important to include in goal setting.?Allowing the parents during workshop activities to share their thoughts, concerns and opinions about health related issues on Flu vaccine, diabetes, and Asthma expectations and feelings in their own words so that their voice can be heard. Communication is important and one part of communicating with parents is to listens attentively to the emotions they expressing in order to render appropriate interventions. Overall, this is a team work effort where everyone’s dedicated to the well-being of the children and their family (community). Describe how the goals were accomplishedGoals are accomplish by evaluating the actions and attendance of workshop participants. In order to know what the community need we had to do a community assessment. This process was easy, because it was done by verbally asking parents in form of a survey what they expects out of this program involving while the nurses are here. By briefly interviewing the parents and getting to know them as individuals to have a more effective intervention. Parent workshops are the main focus to get their health view and understand of the present crisis that the community is in. Answering questions, providing individuals with folders containing teaching materials about screening tools for risk factors and making sure they understand them. During these workshops we don’t only do a lecture but are actively demonstrating and given visuals on how incorporate healthy living habits. For example, in the diabetes workshop we showed parents ways to make soda using 100% grape juice and adding seltzer water to give the bubbling effect as an alternative by cutting out the sugar. We discuss the importance to reduce sugar and show fast and easy way to eat better. We provided proper teaching for hand washing precaution is encourage especially for babies and toddler who’s immune system are still growing during this flu season. In addition we express the importance to maintaining hydration status during the flu season and eating fruits and vegetables such as sweet peppers, oranges, tangerine, kiwi, dark green leafy, kale, etc. Another workshop we did was on asthma management. We provided documents on triggers that can cause asthma attacks. In relations to asthma we stressed the importance to have an action plan for kids with asthma based on their age. They can take these material to their health care provider and discuss the best option for that child. We use multimedia such as projector and where we showed a video of the song “happy” and invited the parents to perform this dance with the kids in their classrooms using the radio. As for the kids we do direct observation while they are in the gross and motor room to assess their growth and development status based on age. We measured them and recorded their BMI using the CDC website BMI calculator to get their weight percentile. We plot those data on the Length-for-age and Weight-for-age percentiles charts that helps us to keep track of the children’s BMI. Another implementation activity we did for the children was we reviewed their charts with physical exams and records date that is use for the Nutrition Questionnaire & Assessment which a nutritionist complete as needed. Although workshops are the main focus for this semester, we do home visits. During the home visit we use the functional health pattern assessment screening tools which is a series of designed questions to screen for behavior that affects the parent’s health. We discuss the results and make referrals for areas in need. Project evaluationBenefits of the ProjectAs nurses even when we don’t think we are making a big difference because change takes time but we do. The benefits of this project to the community is to see this community in the long run defeat the status quo as the most prevalent areas for developing type 2 diabetes. We are driven working towards that goal because as a society we can’t turn the other cheek. We hope that these workshops that we have conducted with the parents are tools that they are using and making part of their daily activity towards quality life improvement. The benefit for the workshops done at FirstStepNYC are focus mainly teaching about health maintenance and promotion as we incorporated it to education. The community will be aware and feel the sense of empowerment to start taking control of their health. We want them to become conscious about making healthy decision in regards to their health related issues. The data provided here at FirstStepNYC well be lifelong lesson learn which parents are able to incorporate into their culture and become the norm of healthy living. We hope to raise more awareness and attention to not only locally but to bring this to government officials in hope of starting a resolution process as a start. The overall benefits is to see a community that is empowered, functional, educated, interested in improving quality of life. Part VI. Evaluation C. Self-Reflection of Service Learning ProjectOlga Andrianova, RN I am proud to say that my clinical rotation was at FirstStepsNYC program located in Brooklyn, New York. I’m thankful for the experience that will help me in my future career and empower me to continue the personal growth. It showed me the importance of the community nursing and the challenges that nurses can face, considering the size of the community with acute health needs and the limit of the resources. It also taught me how important the team work is and that attentive listening can be crucial. I want to take the responsibility and to evaluate my work, achievements, and personal behavior. Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.Every Tuesday from early morning till afternoon our clinical group met at PS/IS 41 located in Brownsville, Brooklyn. I attended every week, in accordance with school schedule, and made sure I was always on time or earlier, if group members needed help in preparations for the workshops. I wore scrubs, or business attire, depending on the guidance of our clinical instructor, but always with the white lab coat and CityTech student identification card on the side. I was assigned the responsibility to carry out one of the workshops. I followed the instructions, asked an additional information and clarification, to make sure the task was satisfactorily completed within the assigned time frame. I never shared the information about families with anyone outside of our community healthcare team. Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community settings. To collect and evaluate health and emotional status of our clients in the community settings, we used Functional Health Pattern Assessment Screening Tool. This tool was the set of questions that collected emotional, physical, developmental, spiritual, and social data that could potentially affect clients’ wellbeing. Based on the information provided, we assessed the problems that needed to be addressed during further interactions with the families. I did not administer any medications or treatments during the clinical practice, however all the principals of personal safety were utilized, such as appropriate, safe clothes, hand washing, and wearing gloves when in contact with body fluids. 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 settings.I was respectful to everyone I met or worked with in the community settings, including the staff members of the program and the students I was in group with. I employed the therapeutic communication at all times; I made sure my body language was concurrent with what I was saying. I communicated through the different channels, such as face-to-face communications, written documentation of assessment data and results of data evaluation, online communication with the instructor and the classmates. Because I had to communicate not only with adults, but also with children up to five years old, I adjusted the communication skills to the developmental needs and age of every client. Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.The parenting workshops that we planned and implemented as a part of our project, had free, conversational style, where parents could feel comfortable to ask questions and share their experience, without any judgment. Parents were provided with the essential information on prevention, management of certain diseases, and the services available inside of the community. Our instructor and staff members of the program always helped us with providing healthy snacks and beverages for parents during the workshops, promoting friendly, warm environment. During the learning sessions with the kids, I implemented it through the game, songs, dancing appropriate for their age. Objective 5: Utilize informational technology when managing individuals and families in the community.We used the excel program to document and organize the data on the clients. It was always confidential, and data results were never left unattended. To research the health information about Brownsville community and services that available for children and adults, we used the reliable websites, such as , , etc. Also our project was based on the objectives of Healthy People 2020 on identifying the health priorities for the community, and informing the individuals about activities that can be implemented to promote health and prevent diseases. Objective 6: Demonstrate a commitment to professional development.I demonstrated a commitment to professional development by continuing my nursing education, and by volunteering for the participation in the FirstStepsNYC program, I showed the readiness for something new and challenging in nursing practice. Any sources of information that I used for research and planning care were always appropriate, up to date, and approved by our clinical instructor. Objective 7: Incorporate professional nursing standards and accountability into practice.As a licensed healthcare professional, I never forget that I have responsibilities and obligations to practice according to approved standards and principles, stated in the American Nurses Association code. I am guided by the code of ethics and evidence-based practice. I understand that I have the knowledge that can and have to be used for the benefit of individuals and the community in a whole, as I am accountable for that. As a part of the FirstStepsNYC I made myself familiar with the program’s mission statement, which focused on helping the struggling families to find their strength and build the foundation for the better future for them and their children. I also followed the standards of behavior of the FirstStepsNYC community program, such as maintaining confidentiality of the clients, providing equal opportunity to all without discrimination or violence, etc. Objective 8: Collaborate with clients, significant support persons and members of the health care team.I collaborated with the members of our health team, such as my classmates and our clinical instructor, in order to ensure the best quality of assessment, planning, providing care, teaching, and evaluating the outcomes. We always encouraged community individuals to make the healthy lifestyle choices, like providing the healthy apple cake recipes and distributing fruits and vegetables during the Fall-Festival that took place at PS/IS 41 in November. Our workshop provided them with the all information needed to make their lifestyles healthier, and prevent the diseases. Each workshop included a list of health clinics, health care resources that were available in the community. Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services. The availability and the delivery of healthcare services in the community are affected by many factors, such as economic, political, social and demographic forces. In the Brownsville community, where the majority of population is unemployed or work for minimal wages and lives below the poverty line, where the streets are not safe and the air is polluted, where the death rates from diabetes and heart diseases are among the highest in Brooklyn, only one hospital is available. To see the health specialists, people have to travel miles. Programs like FirstStepsNYC need to be supported to enroll many more families who needs support and hopes for the better future. Brownsville community, as well as health care professionals, and social services have to vocalize the problem and advocate for the community individuals, because, as a team, we can do much more. Conclusion: To sum up, I want to say that working in the community is very challenging, because of knowledge, skills and patience that are needed, but very rewarding, as well. As a community nurse, you take a responsibility not only for individual, but for the families and whole communities. Community nurse follows up with families for many years and can witness the outcome of her work, of teaching and empowering. Abdul Haq RNAccording to the NUR 4010 Community Health Nursing Clinical Evaluation Tool, there are 9 objectives that need to be fulfilled by Professional Nurses enrolled in the NUR 4010 Community Health Nursing course at New York City College of Technology (NYCCT). These objectives consist of displaying professional behavior and appearance, utilizing analytic reasoning and critical thinking skills when delivering care to individuals and their families in the community setting, communicating effectively with diverse groups by using a wide range of strategies, and ensuring that the environment nurtures learning (Egues, 2014, p. 26-27). Other objectives include incorporating the use of informational technology when delivering and managing care for clients and their families, demonstrating a lifelong commitment to professional learning and development, utilizing professional nursing standards and accountability into practice, collaborating and interacting with clients, support groups, and other members of the health care team in the clinical setting, and understanding how economic, political, social and demographic factors could potentially impact the delivery of health care services to clients (Egues, 2014, p. 28-30).Objective 1. Demonstrates individual professionalism through personal behaviors and appearance.The first objective states that the student "Demonstrates individual professionalism through personal behaviors and appearance" (Egues, 2014, p. 26). This objective entails the Nursing student to demonstrate strong professional behavior and presentation when interacting with colleagues, professors, and clients in the clinical environment. In order to fulfill this objective, we had to demonstrate the professional behaviors of maintaining client confidentiality, assuming responsibility for self learning, preparing for clinical learning, fulfilling assignment requirements on time, seeking professional guidance appropriately, participating actively in clinical conferences, attending clinical courses on time, and wearing scrubs or professional attire when prompted. I successfully performed the expected behaviors in this objective by adhering to HIPAA, as mandated by the NYCCT Baccalaureate Student Handbook, by protecting the health information of the children and parents at First Steps PS 41. For example, when assessing and analyzing the health and weight values of the children, I did not reveal this information to anyone except for my colleagues and the clinical instructor. I also assumed responsibility for my own learning by reading about the fundamentals of Community Health Nursing from Chapters 1 – 16 in the Course Textbook: Community Health Nursing An Alliance for Health by Holzemar and Klainberg on a consistent basis, handouts distributed by Professor Falk such as research and newspaper articles, information about health disparities in Brownsville on websites from organizations such as Centers for Disease Control and Prevention (CDC), New York City Department of City Planning, New York City Department of Health and Mental Hygiene, and the U.S. Census Bureau. Other sources that I used for independent study include resources on the benefits of exercising from reputable websites such as the American Diabetes Association, Harvard School of Public Health, and the National Diabetes Education Program and community resources containing regions to exercise in Brownsville on pages 8-13 from Brooklyn Perinatal Network, Inc's Brownsville & East New York Healthy Eating | Free Active Living Community Resource Handook.I also demonstrated professionalism by completing Clinical and Lecture Assignments on time. Clinical assignments that I completed include preparing worksheets and posters for the Diabetes Prevention Workshop November on 12th effectively to ultimately help in educating the parents on the benefits of eating healthily and exercising to prevent diabetes. Lecture assignment that I also completed on time include submitting the 4 Course Blogs on NYCCT's Blackboard website, submitting textbook related assignments required by Dr. Egues on the NUR 4010 Course website on time, posting the self-reflection and pieces of the Service Learning Project on Open Lab. I also sought guidance from Dr. Egues whenever concerns arised regarding requirements as mentioned in the NUR 4010 Community Health Syllabus. I just would like to thank Dr. Egues for being a supportive Professor that understood the concerns I had with respect to completing the required assignments to the best of my ability. I also participated actively in clinical pre and post conferences during Clinical days to the best of my ability. I recall discussing how I educated the parents on the benefits of exercising to prevent diabetes and the variety of community resources available to perform physical activity in the Brownsville area. I also discussed the challenges that I had with focusing on explaining the benefits of physical activity in preventing diabetes, while a parent was diverting attention away from our agenda of educating the parents on the nutritional and physical activity aspects of preventing Type II Diabetes Mellitus. I also adhered to the NYCCT Department of Nursing's clinical attendance policy by arriving at class everyday about 15-20 minutes before the class began, wearing either scrubs or professionial attire when prompted by the clinical instructor with the NYCCT White Clinical Lab coat and the NYCCT ID card attached. Also, when interacting with the parents, family members, and children, I maintained their confidentiality and did not delivered any information that I received to anyone else not involved in the health care plan at the clinical site. I also did my best to be Professional when interacting with my colleagues in the clinical setting or through Informational technological sources such as text messages, emails, and phone calls. I definetely felt I had to be persuasive and effective in helping my colleagues achieve the desired goals to fulfill the requirements of the course.Objective 2. Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.The second clinical objective is that the student needs to "Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting" (Egues, 2014, p. 26). This objective involves the student assessing clinical data from physiological and psychological perspectives, making appropriately nursing diagnoses, and create plans based upon the assessed data. Certain ways this was accomplished was when the clinical group obtained the heights and weights of the children before and after a 4 week interval, and then the data was evaluated in order to ensure that the children were reaching appropriate physiological milestones. After the 4 week interval, I utilized the medical charts of the students at FirstStepNYC PS 41 in order to assess for optimal physiological, psychological, and social outcomes in the children. For example, health measures related to the clients' self-care needs such as height,weight, and hemoglobin values, and lead values were assessed and evaluated for appropriate levels. Based upon the values, appropriate documentations were made as to whether it was in the best interests of the students to follow up with the Primary Care Providers to help the children maintain or attain optimal health outcomes. After obtaining the objective health variables of height, weight, and hemoglobin, the data was then analyzed and the planning and implementation of Nursing Interventions was based upon these values. It was significant to assess the iron and hemoglobin levels, because if the lead values are high, the lead molecules would displace oxygen from hemoglobin and decrease the amount of hemoglobin produced in the body. The children with low hemoglobin values, such as below 4 ug/dL, have higher priority than those weight abnormal height and weight values, because cardiovascular symptoms such as decreased perfusion takes precedence over less than ideal height and weight values. The hemoglobin values are indicative at to whether the childrens' red blood cells were capturing the optimal amounts of oxygen to be transported throughout the body in order to help the children to attain optimal growth and development. If the hemoglobin levels are below 11 g/dL as specified in the childrens' medical charts, it would be in the best interests of the children for the Professional Registered Nurses to perform physical assessments and determine if the children demonstrate signs and symptoms of low hemoglobin values such as hypercardia, fatigue, apnea, lack of energy during activity, pale skin, and gums (Mayo Clinic, 2012). Thus, it would be appropriate to first recommend the children with low hemoglobin values to be seen by their Primary Care Providers and to educate their parents on the need to consume food high in iron such as dark green leafy vegetables, red meat, poultry, seafood, beans, and iron fortified cereal. Also it would be in the best interests of the parents for the Professional Registered Nurses to educate them on how to prevent their children from being exposed to lead by handing them Lead Prevention Resources from organizations such as the CDC and directly discussing the information with the parents. It would be appropriate to inform the parents that have young children, especially those with lead levels above 4 ug/dL, to avoid access to peeling paint or chewable surfaces with lead based pain, avoid being in houses built before 1978 that are in renovation, regularly wash children's hands and toys, consistently wet mop floors, and prevent children from playing in bare soil (Centers for Disease Control and Prevention, 2014). It is important to perform the appropriate nursing interventions for the children with high leads values and low hemoglobins by referring the children to their Health Care Providers and to deliver educational instructions to the parents regarding how to decrease their childrens' contact with lead in a timely manner so that the children would not be enduring low oxygens levels in the blood due to low hemoglobin levels. It is important to implement these interventions promptly, because the children may experience growth and development delays with prolonged hypoxemia secondary to low hemogloin levels. By doing so, we would do our best to ensure that the children are living in safe environments free from the presence of lead. After implementing the interventions for the children hemoglobin values below 11 g/dL and high levels above 4 ug/dL, it would then be appropriate to follow up with the parents of the children that were below or above expected height and weight levels, and educate the parents on methods of helping the children to achieve optimal health outcomes. For example, if the child was above the 90th percentile for weight and was at the 70th percentile for height, the parent would be advised that the child is at an appropriate height, but just would need to lose some weight in order to be at a normal weight. Certain methods of helping the child to lose weight would be to advise the parent to reduce the amount of fat and sugar given to the child and substitute these products for a higher proportion of fruits, vegetables, and carbohydrate products high in whole wheat and fiber. However, it is important to understand that the best way to determine if the children are reaching normal height and weight values is to follow up with the children by remeasuring their heights and weights after a certain period of time. The heights and weights of the children were in fact remeasured about 4 weeks after they were obtained in October of 2014. Based upon the remeasured values, the instructions delivered to the parents by the Professional Registered Nurses regarding whether the interventions should be modified based upon whether the heights and weights of the children have increased or decreased. For example, since it was discovered that one of the children that had his weight above the 90th percentile 4 weeks ago now has a weight below the 10th percentile, the nursing plan of advising the parent to reduce products high in fat and sugar should be modified instead for the child to consume a high carbohydrate and low fat diet to reduce the rate as to which he loses weight. In addition to modifying the plan of care based upon newly acquired height and weight values, it is important to continue utilizing analytic reasoning and critical thinking skills by applying the principles of personal safety when working in the community setting. I utilized the principles of personal safety when caring for the children by ensuring that the children were not walking on wet surface where they may fall and injury themselves, ensuring that the children were not carrying heavy items that could fall and hurt the children, and ensure that the children were not being too aggressive with one another. 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 settingThe third clinical objective that was fulfilled involves effectively communicating with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting (Egues, 2014, p. 27). As Professional Registered Nurses, one of the most important tasks that we could perform is communicate effectively with our clients. When we are communicating effectively with our clients, we are better prepared to understand the unique health needs of our clients. It is important to understand though that we need to communicate with our clients in ways that coincides to their developmental needs, for example, some of the parents at PS 41 are unable to read at an appropriate grade level, and thus need to acquire information through verbal means or by acquiring informational material that does not contain complicated jargon and instead coincides with their respective reading levels. Other methods in which we could communicate effectively with our clients is to be deliver therapeutic communication skills by adhering to the unique cultural beliefs and practices of the clients, and delivering consistent ongoing, compassionate, and supportive encouragement to the client. An example of a situation in which the culturally competent Nurse enhances hiscommunication between him and a client of a different culture is if a Community Health Nurse was preparing nutritional counseling for a South Korean male client. In this context, it would be important for the Registered Nurse to understand that South Koreans tend to incorporate family members into their decision making process. Thus, the Nurse would be likely to enhance communication between him and the client, because the client is likely to understand the the Nurse is delivering health care in a way that respects and acknowledges his unique cultural preferences.In addition, I utilized therapeutic communication with the families of the children at FirstSteps PS 41 by using Harry Stack Sullivan's Interpersonal Relationship Approach of delivering consistent compassionate and supportive encouragement to the parents when they expressed the inability to consistently follow the health habits of eating a healthy diet and acquiring optimal physical activity to prevent diabetes. With respect to Sullivan's Interpersonal Relationship Approach, Sullivan conveyed the concept that individuals can not easily relate to a therapeutic person such as a Registered Nurse or other Health Care Proessionals, but instead require ongoing, compassionate, and supportive encouragement to be cognizant to the fact the person is trying to help them (Arnold & Boggs, 2011, p. 9). This therapeutic relationship approach is beneficial in this situation where some of the parents have expressed the concerns that they are unlikely to follow the suggestions of the Registered Nurses, because they do not have the time to prepare healthy food at home and exercise. They do not have the time to perform these activities as they are working full time and they are experiencing significant stress from their child rearing roles as parents. In this situation, it is essential to continuously and consistently inform the parents that we will always be available to support them by delivering useful information as advocated by Sullivan, although they are experiencing stressors in their personal lives. A situation in which I had to utilize effective therapeutic communicational methods was during a Diabetes Prevention Workshop that I was a part of for the Community Health Nursing Course. I was developing initial relationship with the clients by first introducing myself as a member of the Health Care Team as a Professional Registered Nurse that is also pursuing his Bachelors of Science degree in the Major of Nursing at NYCCT, that has the intended goal of raising the parents' awareness about diabetes and how exercise could be a valuable strategy in reducing the disease. I then discussed some of the initial concerns the parents had and focused on their needs and not just the agenda that was agreed upon by my Workshop Group Member and myself. When focusing on the individual needs of the parents, I was addressing the specific concerns the parents had and helped them to dispel misconceptions that they may have with regards to diabetes and how exercise could be used to reduce the diseases' severity. For example, one of the parents discussed the barriers she had with respect to exercising, such as lacking the optimal time and motivation to exercise due to time constraints and immense stress from her daughter respectively. Based upon this parent's needs, I first discussed with her the benefits that exercise not only has in reducing weight to reduce the impact of insulin resistance on the progression of diabetes, but that exercise could be a potential stress relieve to help mitigate some of the stressors in her life. This occurs, because when one exercises, blood circulation is improved throughout the body and thus oxygen delivering to the cells and tissues are enhanced to ultimately improve the body's ability to carry out its metabolism and better cope with stress. I encouraged the parent to think about ways that she could dedicated 5 minutes, whenever possible, to implementing moderate to light exercise routines. I instructed her and the group that when you exercise for about 15 – 20 minutes everyday for 5 days a week, you not only reduce your weight, but you also reduce the effect of insulin resistance on promoting diabetes in the body. However it was important to inform the parents that they do not have to begin exercising on a vigorous level, but that they could begin an exercise regimen of walking for about 5 – 10 minutes for a few days and then gradually increasing the intensity of the exercise regimen to about 15 minutes of moderate exercise in a form that the parents enjoy. After instructing the parents on the importance of exercising in preventing diabetes, it was important to follow up with these parents in order to determine whether they were exercising effectively and were locating suitable areas to implement exercise regiments in the Brownsville region. Certain questions we could ask the parents to determine whether they are learning from the educational sessions are whether or not they are exercising more often than before, how much weight in pounds have they lost, and have they felt as if they are more empowered to exercise more often after the nursing protocols in the form of Diabetes Prevention Workshops were implemented.Objective 4. Establish environment conducive to learning and use a plan for learners based on evidence-based practice.The next clinical objective involves ensuring that the environment is conducive to learning and utilizing a plan for learners based upon evidence based practice. I believe I accomplished this objective during the Diabetes Prevention Workshop by creating an environment conducive to learning by informed the parents that the workshop was not designed to intimidate anyone or to blame anyone for having diabetes or being at risk for the condition, but that the parents were free to bring any questions they had regards methods of preventing diabetes. During the workshop, I also established an environment that fosters learning by advising the parents on the benefits of adhering to an exercise plan that would help to prevent diabetes by helping them to lose weight. This plan is not a strict method that consists of a certain number of repetitions or tasks to be done on a repetitive basis, but instead could involve spending 10-15 minutes for about 5 days a week walking with friends and family in various parks around Brownsville, Brooklyn, in order to encourage the parents to take part in more physical activity with their families. This would not only give the families opportunities to spend more time with their children and their close ones, but they would also be involved in physical activity which could on the long run, potentially help them to lose weight and reduce their risks for developing Type II Diabetes Mellitus. After the Diabetes Prevention workshops, it would be appropriate to evaluate whether or not the parents have learned more about how to prevent diabetes from physical activity standpoints. I determine that some of the parents have learned more about the benefits of exercising from the Diabetes Prevention Workshop by interviewing some of the parents individually and asking them whether they learning more about the relationship between physical activity and the development of Type II Diabetes Mellitus. I also asked them if they are aware of parks and recreational facilities listed in the Brooklyn Perinatal Network, Inc pamphlet that they would prefer to engage in physical activity at Brownsville, Brooklyn. While evaluating whether or not the parents have learned more about how to prevent daibetes, I would reinforce some of the teaching components that were addressed during the actual Diabetes Prevention Workshop.Objective 5. Utilize informational technology when managing individual and families in the communityIt was also essential to comply with the 5th Objective of the NUR 4010 Clinical Evaluation Tool by incorporating the use of informational technology (IT) when managing the care of individuals and families in FirstStepsNYC PS 41. First of all, it is important to understand that when discussing the use of technological resource in the nursing field, we are discussing the field of Nursing Informatics. According to the American Nurses' Association (ANA), nursing informatics is a specialty that combines nursing science, computer science, and information science to better prepare nurses to advocate for the best interests of their clients (American Nurses Association, 2008). Nursing informatics was used in the clinical setting when I calculated the Body mass indices of the children by inputting their heights and weights onto the Center for Disease Control website and then compute the BMI values. The BMI is an invaluable value that utilizes the heights and weights of children and adults to determine whether they are underweight, at normal weight, are overweight, are obese, or morbidly obese as correlated to their height. The BMI is calculated by dividing the childrens' weights in kg by their heights in meters squared. This process of using websites such as from the CDC could be used by parents to determine whether their children are at appropriate weight values based upon their heights. Based upon the BMIs of the children, the parents could reduce, maintain, or increase the amount of food their children consume. I have and will continue to advocate for the parents to use the CDC website by inputting their childrens' heights and weights in order to determine their BMI. So we can see that IT has the ability to improve nursing care by converting patients information, such as heights and weights, to other variables such as BMIs with health implications that could be easily explained to the parents. In addition to helping parents use IT from professional websites such as The CDC to improve their knowledge of their childrens' health as measured in BMI, there is a risk for patient confidential information to be compromised when utilizing electronic or paper records. Thus, while utilizing the heights and weights of the children to calculate their BMI from websites, it is of highest priority to protect this data from people who do not have the professional responsibility to care for these clients. I maintained the private health related information of the children by not discussing the information with others who are not part of the health care team involved in caring for the client, making sure others were not looking at the data collected from the children and analyzed, and using subtle patient identifiers when discussing protected health information about the children in areas where bystanders may hear patient information. Objective 6. Demonstrate a commitment to professional development. I also demonstrated a commitment to professional development, as mandated by the 6th objective, by utilizing current literature to assess and analyze health disparities for families living in Brownsville and to plan appropriate interventions based upon the disparities. According to the NY City Department of Health and Mental Hygiene (2013), Brownsville had high rates of age-adjusted diabetes related deaths at 177 people out of 100000 people. In order to help mitigate the risk of the parents of the children and the children attending PS 41 from developing diabetes and facing life threatening conditions due to the disease, I located a variety of resources to educate the parents on methods of reducing their risks of developing diabetes.As previously explained in the section discussing Objective 4, I encouraged the parents to exercise for about 15-20 mins a day for 5 days a week. However, the process of create such recommendations required for me to located a variety of articles from reputable organizations, such as the Harvard School of Public Health and the National Diabetes Education program, that consisted of information related to the health benefits of exercising on reducing the impact of diabetes on individuals. An example of a research article I used when planning care for clients at PS 41 was Harvard School of Public Health's (2014) article titled "Simple Steps to Preventing Diabetes," in which I located valuable figures to be relayed to the parents such as being overweight and obese increase the risk for developing diabetes 7 fold and 20 to 40 fold respectively. The article also contained information that explained the value of utilizing the muscles to improve the ability to use insulin and thus have reduced insulin resistance that would ultimately reduce the risk or progression of developing Type II Diabetes Mellitus.The process of locating sources, such as from Harvard School of Public Health, that are used to help educate the parents on methods of exercising effectively also require for me to engage in independent research and self studying. Similarly to practicing as a Professional Nurse and an RN-BSN student at Brownsville, Brooklyn, I would also be performing research and studying independently in order to educate myself on the topics of highest priority for my clients in future health care settings. Of course, this involves being part of a life-long educational endeavor that proves that I do not know everything there is to know about the Nursing or Medical field, but that I would be diligent in taking the appropriate actions to educate myself on topics I am unfamiliar with to produce the most optimal and cost effective health related outcomes for my clients. In additional to being responsible for life long learning, I would also consistently evaluate my performance as an independent community health nurse. As a current Registered Nurse that is pursuing his Baccalaureate of Science Degree with a Major in Nursing, I have been influenced by this course and Dr. Egues to continue working and improving my skills set as Community Health Nurse. Currently, I function as a Community Health Nurse at a Senior Center in Queens, NY performing Primary Preventative Tasks, and I would engage in lifelong learning in my specialty by consistently educate myself on recent research articles and updates in the Community Health Nursing field. By doing so, I would being doing my clients a great service in functioning as a Community Health Nurse that is reevaluating his skills and looking for ways to improve his knowledge as an Independent Nurse in the Community Setting. It is important for me to consistently self-evaluate myself by engaging in lifelong learning so that I would have the most recent skills and knowledge that would enable me to function as an Independent Registered Nurse that does not require consistent supervision and guidance from Health Care Providers and other members of the health care team. Objective 7. Incorporate professional nursing standards and accountability into practice.As a Professional Registered Nurse taking a Community Health Nursing class at FirstStepsNYC PS 41 in Brownsville, Brooklyn, it is important to adhere to professional nursing standards and accountability while practicing conventional Nursing and Public Health Nursing, First Steps PS 41's standards of practice, professional behavior as specified by the New York City College of Technology's Department of Nursing Baccalaureate Program Nursing Student Handbook, and FirstStepNYC's mission. According to the ANA, during Public Health Nursing Practice, Registered Nurses must promote and protect the health of populations from nursing, social, and public health sciences sources (Holzemer & Klainberg, 2014, p. 13). I believed that I promoted and protected the health of the parents and children at First Steps PS 41 by advising the parents on the health hazards of excess weight and inactivity on promoting diabetes from organizations such as The American Diabetes Association, Harvard School of Public Health, and the National Diabetes Education Program. An example of such health hazards that was conveyed to the parents is that every two hours spent on sedentary activities increases the probability of developing diabetes by 14 percent (Harvard School of Public Health, 2014). It is also important to demonstrate appropriate clinical behavior in FirstStepsNYC PS 41 at Brownsville, Brooklyn as specified by the Baccalaureate Program Nursing Student Handbook (2014). As mandated by the Baccalaureate Program Nursing Student Handbook (2014), I displayed appropriate clinical behavior by wearing scrubs or professional attire as mandated by Professor Falk, the NYCCT Nursing Department's White Laboratory cord with the NYCCT ID, and NYCCT emblem to the clinical site, not utilizing electronic devices for personal business during the clinical setting, complying with the Health Insurance Portability and Accountability Act by protecting the Health Information of the clients at PS 41, not smoking or using tobacco in the clinical site, complying with the Drug-Free Schools and Communities Act Ammendments of 1989 at the site, and staying up to date with CUNY's email alert system for emergency notifications. I also adhered to other policies as required by the Baccalaureate Program Nursing Student Handbook such as arriving to class prior to the beginning of the 8:30 am clinical start time, and crediting all external sources used when completing required course assignments for NUR 4010 Community Health Nursing. In addition to adhering to the ANA's Nursing Standards of Practice and the the Baccalaureate Program Nursing Student Handbook's policies, it is important as Professional Registered Nurses to also comply with the standards of practice and mission of the clinical site we are at, which is FirstStepNYC PS 41's in this situation. As per the SCO Family of Services' Handbook for Program and Support Volunteers/Interns (2012), RN-BSN students such as myself followed the policies of not engaging in intentional or unintended harassment to any individual, not engaging in violence, not consuming drugs of alcohol on site, reporting mandated cases of suspected child abuse or neglect, and maintaining the confidentiality of the parents and children at the site. I also abided by the SCO Code of Ethics as listed in the SCO Family of Services' Handbook for Program and Support Volunteers/Interns (2012), in which I demonstrated cultural competence in providing services consistent with the unique cultures of clients, maintained the client's right to privacy, did not practice discrimination based on factors such as race, color, national origin, citizenship status, religion, etc, did not practice dishonesty, fraud, and deception, helped to strengthen the relationships among the people at the site, and did not accept gifts in excess of $50. It is also important to understand that according to the FirstStepsNYC Early Education Leadership Institute webpage on the SCO Family of Services' website (2014), their mission is "The FirstStepNYC Early Education Leadership Institute is designed to prepare and support current and future leaders to improve outcomes for all children and families by advancing quality and best practice in early education settings." I believe that I effectively carried out this mission through various educational activities to improve the health outcomes of the parents and children at PS 41. Such activities include participating in two Family Workshops besides the Diabetes Prevention workshop conducted by other members of the Health Care Team at PS 41, which emphasized the importance of acquiring the Flu Vaccination and methods of preventing Asthma. I explained to the the parents that the influenza virus mutates every year and becomes resistant to the previous year's flu vaccination and the body's immunity, and thus it is in the best interests of their and their families' health to acquire the vaccination that would reduce the symptoms of the influenza virus. Objective 8. Collaborate with clients, significant support persons and members of the health care team. While adhering to professional nursing standards and accountability during the Community Health Clinical Setting and fulfilling the other clinical objectives as specified in the Course Handbook, nothing could be more important than communicating with the clients, the clients' significant support members, and other members of the health care team. Fulfilling this objective required that I collaborated with my fellow Nursing colleagues or Professor Falk when planning or implementing Nursing protocols. For example, when analyzing the heights and weights of the children attending FirstStepsNYC PS 41, if the values were above the 90th percentile or below the 10th% percentile, it was essential for me to communicate this concern to my colleagues and the Professor in order to determine what would be the next action to take. When I informed Professor Falk that certain children were above the 90th percentile in weight, she informed for me to document this information onto a Manila folder and when the parents were available, to educate them on methods of reducing the weight of their children. During the educational processes during the Diabetes Prevention Workshop and on one-on-one educational sessions with the parents, it was essential for me to focus on two areas of Diabetes Prevention: nutrition and exercise. I referred the parents to and distributed the Brooklyn Perinatal Network, Inc's (2014) Pamphlet titled Brownsville East New York Healthy Eating | Free Active Living Community Resources, in order to assist them in locating sources with high concentrations of healthy foods on pages 5-7 and areas where the parents could exercise with their children and friends on pages 8-13. This would not only give the parents information on how to eat healthily and exercise more often, but this resource empowers and guides the parents to make the independent and health consciousness decisions to locate more healthy food products and participate in more physical activities. In addition to empowering and guiding the parents to eat more healthily and exercise more often through the distribution of Community Resources, I also informed the parents that when their children are overweight, they are at higher risks for continuing to be overweight when they are adolescents and to potentially develop chronic diseases in early adulthood or even sooner. Such chronic diseases include Hypertension, Diabetes Mellitus Type II, and Coronary Artery Disease. While educating the parents on methods of reducing the weights of their children, I implementing the therapeutic intervention of health education based upon the immediate health needs of the children, which in this situation is the status of being overweight. I also believe it would be in the best interests of the parents and their families for the clinical group to help in assisting them in making connections to community agencies in Brownsville such as The Brownsville Partnership (BP). BP is a network of organizations and residents that has the goal of solving economic instability concerns in the house, health, and public safety realms in Brownsville, Brooklyn (Community Services, 2014). By referring the parents at FirstStepsNYC PS 41 to BP, they would acquire the advantages that BP gives to people living in Brownsville, which includes connections to jobs and access to living arrangements. Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services. The last objective that needs to be fulfilled by Nursing Students enrolled inCommunity Health Nursing in the Spring 2014 semester is understanding the role that economic, political, social and demographic forces play in influencing the delivery of health care services (Egues, 2014, p. 30). It is important to first understand the gaps present in the care system in Brownsville, Brooklyn. Health care facilities such as Brownsville Multi Service Family Center on 592 Rockaway Avenue, the Paul J. Center for Human Services on 106 New Lots Avenue, and East New York Health at 1620 East New York Avenue, and Brookdale Hospital on One Brookdale Plaza are available. The most comprehensive health care facility in Brownsville, Brookdale Hospital, is a major tertiary medical center that offers a variety of medical services such as Ambulatory Specialty Services, Family Care Services, Pediatric services. Unfortunately this facility is a ten to fifteen minute walking distance from the Brownsville area, that is simply inconvenient for most Brownsville residents with health conditions, children, and other situations to travel to. As a result, parents, families, and children are less likely to receive the most comprehensive health care services such as annual physical examinations and checkups from Primary Care Providers, annual vaccinations, and screening resources to prevent and delay the onset and progression of chronic diseases such as Hypertension, Type II Diabetes Mellitus, Breast Cancer, and Coronary Artery disease. So it is clear that the most perceived dilemma in the delivery of health care in Brownsville, Brooklyn is the lack of Primary Care Health Clinics in the area.Thus, the facilities in the Brownsville area are unlikely to effectively address the rising rates of health disparities in the region. Such health disparities prevalent in the Brownsville region are 29.3% of the residents being obese (New York City Department of Health and Mental Hygiene, 2013), diabetes related mortalities at 177 deaths out of 100000 people (New York City Department of Health and Mental Hygiene, 2013), higher risks of developing asthma due to air pollution, and "16.1%" of Brownsville and Central Brooklyn residents smoking compared to 15.5% of people living in New York City (New York City Department of Health and Mental Hygiene, 2013). Based upon the high prevalence of health disparities and diseases impacting the residents in Brownsville, there is a need for Professional registered Nurses such as ourselves to convinence Community Board Leaders to dedicate significant resources to establish Primary Care clinics and health care facilities to mitigate the rising rates of risk factors and chronic diseases among residents living in the Brownsville area. By doing so, we would not only help prevent the onset and progression of these chronic diseases, but we would improve the physiological and psychological livelihood of the families by reducing suffering due to chronic diseases and to ultimately improve their lives. However in the meanwhile, it is important for the Registered Nurses to serve as a change agent for parents that are at high risk for developing or already having diseases such as Type II Diabetes Mellitus and Hypertension by referring them to other health care resources. I have referred parents to health care resources by giving them the websites of health care facilities in the Brownsville regions such as Brownsville Multi Service Family Health Center's website at , The Paul J. Cooper Center for Human Services's website at , and Brookdale Hospital's website at . Abdul Haq RN's Summary of Self-ReflectionMy experiences in the clinical and didactic portions of NUR 4010 Community Health Nursing has been educational, challenging, and inspiring ones. Practicing as a Professional Registered Nurse and an RN-BSN student in FirstSteps PS 41 by participating in Parenting Workshops that discussed various topics, such as diabetes prevention, and acquiring the heights and weights of the children has taught me the value of utilizing my knowledge of Nursing Science and my didactic skills from a Primary Preventative perspective. I believe that my experience in the Community Health clinical setting has enhanced my capacity to perform additional health care interventions as a Community Health Nurse in my Work Site at the Senior Center. An example of such a way I would do so is by preparing posters and demonstration that are visualizing appealing and most importantly, educational and empowering to the clients. When I have resources or health care demonstrations that captivate the attention of my clients, I am more likely to acquire more attention from clients that may be interested in improving their health, but may be reluctant in interacting with health care professionals that they did not have contact with previously. With respect to the didactic portion of the NUR 4010 Community Health Nursing course, Dr. Egues has educated me on the importance of first assessing factors such as health disparities and social factors of the community that you are functioning in. This is important, because after assessing the physiological and social aspects of the community we are working at, we would be able to prepare appropriate nursing interventions that address the prevalence of certain chronic diseases in the region we are practicing in. In fact, assessment is the first aspect of the Nursing Process that should be conducted by the Professional Registered Nurse whether he is in the Hospital or the Community setting. An example of when I conducted the health assessment of a community was when I have discovered that the Senior Center I work at has a large Hispanic population that has a high prevalence of hypertension and diabetes. As a result, I would recommend my clients to consume food low in sodium and carbohydrates, but still retains the cultural aspects that are common among Hispanic diets. In addition to the role that the course enhanced my perception in the importance of assessment while functioning as a Community Health Nurse, I believe that my experiences in the Clinical and didactic portions of NUR 4010 Community Health Nursing correlate with one another. I believe so, because the aspect of transferring the delivery of Nursing Care in the bedside to the community, as learned about during the didactic portion, was certainly applicable and evident at the Clinical site at PS 41. During the didactic portion, I learned that the Community Health Nurse utilizes the 5 components of the Alliance of Health Model which are the Vision of the client, the Expertise of the provider (Nurse and Interdisciplinary team), Community Based needs, Systems of care management, and resource allocation, in order to provide high quality and cost effective care in the community that usually lacks the vast array of resources available in the hospital setting (Holzemer & Klainberg, 2014, p. 60). I witnessed the utility of these 5 components in the clinical setting, when we used our knowledge of disease prevention and health promotions in order to reduce the impact of certain diseases on the clients at PS 41, such as Type II Diabetes Mellitus in the Brownsville community. We conducted Health Promotional activities through various modalities such as by implementing Parent Workshops that discussed the topics of the Flu Vaccination, Diabetes Prevention, and Asthma Prevention. During these workshops, we delivered information regarding the main topic of the workshops as care providers and then answered individually specific questions that the clients had. After the workshops, I then referred some of the clients to organizational websites, such as the CDC and the Harvard School of Publication,where they would locate additional informational fabout the topics discussed in the parenting workshops conducted in the clinical course at PS 41.So I do believe that the didactic and clinical aspects of the NUR 4010 Community Health Nurse Course correlate with one another in an effective way that enhanced my ability to function as a Community Health Nurse in my work setting to ultimately produce high quality and cost effective health care outcomes for my clients.May O. Lightfoot, RNObjective 1: Demonstrates individual professionalism through personal behaviors and appearance.There is a certain composure and performance expected of the community health nurse within the clinical setting which conveys commitment to, and respect of the community and the work s/he is contracted to perform. I did my best to perform these behaviors by various actions. I maintained client confidentiality by handling client information (such as heights and weights of the enrolled children) and charts according to HIPAA standards to maintain privacy and safety of personal and private data. I assumed responsibility for my own learning by seeking out clarification and answers to unknowns, through the teachers and employees at FirstSteps, my professor at the clinical site, or through external research, to ensure accuracy of data and of my practice. I prepared for clinical learning by doing the reading and research necessary to arrive at the clinical well-informed of the subjects we were pursuing greater understanding of. I completed assignments within the designated time frame according to the professor’s instruction and to the clinical site’s timeline of needs, so as to be prepared for presenting in parenting workshops, to assist with others’ presentations, or to engage in the classroom/daycare setting. I sought out guidance through FirstSteps employees, administrators and teachers, as well as through my clinical professors to clarify the direction of work, the correct performance approach or to enrich my understanding of the work at hand. I participated in clinical conferences through pre- and post-conferences via question-and-answer format, as well as through emailing, so as to maintain a personal enrichment and growth in my understanding of the community and the material of study, as well as to achieve clarity of any personal uncertainties that I struggled with. I arrived at the clinical site on time and prepared to engage in clinical work. I dressed according to clinical guidelines, which specified clean scrubs with white shoes for the majority of clinical days or alternately with business attire for workshop presentation days, both accompanied by the lab coat with NYCCT insignia as well as visible school ID. Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.Analytical reasoning and critical thinking skills are necessary when providing client care in order to collect relevant data and synthesize the data in a way which contributes to the meeting the needs of the client in an efficient and effective manner, while conveying a respect for and commitment to the client’s needs and unique perspective. This was achieved by various methods. I gathered client data through utilization of many mediums such as nutritional assessments, enrollee's charts, group parenting workshops with question-and-answer sections, and co-delegating work to team members to ensure all necessary data was collected and processed. I assessed the impact of holistic influences on the client’s health status by making direct inquiries to parents as to barriers to achieving optimal health status, and by contributing to a comprehensive community assessment of Brownsville through extensive research to determine the various elements of health status impact. I participated in collecting significant data by honing in on the particular risk-factors of the Brownsville inhabitants and collecting data that reflects insights into the client’s orientation to those high-risk diseases and their barriers to self care that might be mitigated through the community health nurse’s collaboration. I completed physical assessments of selected clients through the above-listed methods of focused inquiry and helped to process that data through data-input and translation into meaningful measures such as calculating client BMI’s and percentiles of growth and development. I prioritized care by focusing on the high risk factor health contributors such as BMI, growth measurements, serum lead levels and nutritional assessments and focused care and teaching in a manner related to those factors. I applied priority-setting in developing and implementing safe and appropriate nursing interventions by tailoring my interactions with client’s according to their developmental capabilities and needs, such as facilitating handwashing and toothbrushing with three year-olds before and after meals, bathroom use and outdoor activities, as well as conducting parenting workshops containing data relevant to parenting obstacles. I evaluated the outcomes of my nursing care by assessing parent’s understanding of the information provided and presented, as well as observing and facilitating the children’s independent abilities to perform health-promotional activities. I was reflective of my practice by clarifying issues and questions of parents when they expressed uncertainty as a result of the evaluation of their understanding, as well as facilitating the completion of healthy behaviors with the children by helping to wash their hands or put on coats to stay warm in the cool weather when going outside. I utilized the principles of personal safety by maintaining good hygiene and wearing personal protective equipment as indicated. 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. There were a variety of methods used to communicate with the client’s in the community regarding meeting their health needs. I engaged in therapeutic communication skills so as to convey compassion and commitment to the client’s experience and needs while engaging in one-to-one conversation as well as in a group setting. I utilized the appropriate channels of communication such as conversation within the clinical site and regarding health-promotion techniques and barriers, so as to not intrude upon the client’s sense of personal space and boundaries. I communicated clearly and effectively with the healthcare team in pre- and post-conferences, during the clinical activities as well as through email exchanges as necessary. I communicated significant data to the instructor and healthcare team by pointing out opportunities for useful nursing interventions. I adapted my communication with clients according to their developmental needs by engaging with the children at their developmental level and through encouraging each to meet their next developmental goals. I reported and documented assessments using the formal assessment tools provided and identified the nursing interventions utilized to facilitate health-promoting behaviors.Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice. I developed and implemented a teaching plan for adult parents and caregivers in the FirstSteps clinical setting regarding diabetes prevention, highlighting effective nutrition and exercise habits. I established an environment conducive to learning by constructing an engaging demonstration to illustrate accessible ways of transforming risky behaviors and habits to those which are health-promoting. I provided colorful and concise handouts of educational literature and local resources relevant to the teaching plan and community. I evaluated learning through open-ended question and answer sessions to establish where gaps in learning or lack of clarification might exist with the caregivers. Objective 5: Utilize informational technology when managing individual and families in the community. I utilized principles of nursing informatics in the clinical area by inputting data that our clinical group collected into the client’s charts to complete an assessment of where health risks might lie in the individual and the community. Data was also collected and synthesized regarding caregiver perceptions of self-empowerment and health behaviors, and examined to determine community trends. Confidentiality was maintained by HIPAA standards. Objective 6: Demonstrate a commitment to professional development. I used the appropriate current literature in planning care for my clients such as determining the relevant developmental goals for the age group that I would be working with on a particular clinical day, or using census data or seeking out current research through reputable sources to inform the interventions I developed. Through the process of developing community resources and interventions, I acknowledge that each community grows and develops over time in a myriad of ways that I need to keep abreast of, so as to provide relevant, appealing and effective interventions to my clients. As I provide the client/community care and collaboration, I evaluate the quality of my engagement, behaviors and techniques so as to continually adjust them to meet the client’s needs in the most effective manner and to prevent any personal negative or judgemental feelings from filtering into the service I am providing. I have strived to adjust to the challenges of practicing independently in the community by seeking out resources inherent to the community and collaborating within the community to fulfill their needs that I am there to meet. Objective 7: Incorporate professional nursing standards and accountability into practice. I utilized ANA standards in the clinical practice so as to convey professionalism and act within the interests of the clients. I complied with the agency standards of practice so as to meet policy guidelines that ensure a safe and effective environment, such as getting fingerprinted and background checks. I became informed of FirstSteps mission by attending meetings with the administrators to ensure that I was working in conjunction with it’s objectives and I held myself accountable for my actions by adhering to the professional guidelines. Objective 8: Collaborate with clients, significant support persons and members of health care team. I worked along side FirstSteps employees, administrators and teachers to facilitate the client’s health potential. I connected with caregivers in workshops to determine areas of their interest and knowledge gaps, so as to tailor my interventions to be most effective for the individual client. I identified local resources such as farmer’s markets, community gardens and health facilities that were accessible and relevant to my clients. I guided the clients, be they parents or children, in seeking health-promoting behaviors to avoid potential health risks and develop healthy habits and patterns. I facilitated client connections by providing them with local health resources and arming them with educational information. Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.I acknowledged the gap in the care system, having engaged in a thorough community assessment and detecting the limited health resources available to this highly at-risk community due to their severe economic disadvantages, as well as historically oppressed ethnic status. I sought out solutions to these problems such as having health care providers embed in the already-existing community structures such as schools, and networking to disseminate resources and health-promoting education. I facilitated change by advocating that caregivers/parents access health resources that are available and accessible to them and providing instruction as to the import of changing and implementing positive health behaviors. May Lightfoot’s SummaryThe lecture setting and course work were well matched to the clinical site and objectives at FirstSteps. The course work guided me in understanding how to assess a community and comprehend it as a broad, dynamic and interwoven set of elements that work together to have a significant impact on its residents health status. Using this didactic framework, I was able to examine my assigned community of Brownsville, Brooklyn and it’s microcosm of FirstSteps and cull the myriad resources to gather relevant data to assemble a picture of the community, it’s health needs, risks and it’s obstacles and potential resources in order to develop an action plan to meet the community’s needs. The coursework directed me to remain focused on the voice of the client as the unique entity which is to guide me to pull the current research together and tailor it in such a way as to be digestible and engaging to my particular community client of focus. I was guided by the coursework to learn to engage collaboratively with the full interdisciplinary team at the clinical site to integrate my health-promotion focus into their education-based focus to achieve the full potential of the client’s well-being. I experienced how the community’s voice asserts itself and requires prominence in the planning and implementation meeting the client’s needs. This assertion and the struggle to find the adequate and effective resources within the community was a challenge that helped to strengthen and broaden my professional growth.I found that I was working in an environment mostly unfamiliar to me, alongside children and parents. This context pushed me outside of the bounds of the normal facility and ease that I typically work in, with independent and singular adults, into one where I worked with children and engaged in the challenging dynamic of parenthood. This was a personal challenge to me, which forced me to confront my sense of inadequacy and awkwardness of interacting with children and develop a greater sense of comfort and new strength in this type of interaction. It also confronted my sense of inadequacy of believing that I did not have much to contribute to in terms of parenting health-suggestions, due to a standpoint of lacking experience. Engaging with parents and doing the work required to be prepared to provide them with my support, information and resources, revealed that regardless of my lack of formal parenting experience, my training and commitment as a nurse enables me to bring a relevant contribution to the parent-client. In addition, working alongside the staff who have experience, ease and willingness to help, facilitated the development of the skills that I strengthened in the classroom setting. Li Xie, RNIntroduction: My clinic site for Community Health is FirstStepNYC in Brownsville, Brooklyn. The clinic rotation gave me a chance to achieve personal and professional growth by working with educators, team members, and people from community. There are nine clinic objectives that helped me to better understand the role of a Community Health Nurse.Objective 1: Demonstrates individual professionalism through personal behaviors and appearance. Our group meet at FirstStepNYC every Tuesday from 8:30 AM to 12:30 PM. In the orientation at school, professor stressed the importance of dressing professionally at the clinic site. Every time we met, I made sure that I dressed professionally and wore a white lab coat with City Tech emblem. My group members were willing to help each other, and it helped me to complete my assignments within designated time frame. We had pre-conference and post-conference. During the pre-conference, professor informed what we had to do for the day and went through related information with us, and in the post-conference, we actively shared our experiences and discussed our thoughts. Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. When prepared the content of our parenting workshops, we focused on what people in Brownsville need to know instead of what we know about the health related topics. The best outcomes of the parenting workshops can only be achieved when parents were more actively engaged in the learning. Our group members tried not to use medical terms and make the content clear and simple. More open-end questions were used to encourage parents to share their concerns and thoughts. In order to make the workshop more entertaining, we used creative methods such as showing our happy dance video and playing Jeopardy games with parents. 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.The kids in FirstStepNYC are range from new birth to 5 years old. When talked with young kids, I made sure that my communication was age appropriated. I talked with children at the their eye level and allowed them to express thoughts or feelings without interruption. When I measured their height and weight, I tried to keep instruction brief with simple words and for short attention span. When talked with their parents, I used more open-end questions to let them share their experience and thoughts. It helped me to establish a trustful and respectful relationship with them. After that, I would more focus on specific health related topics, identifying problems and their strength and weakness. Before discussing any health related topics, I learned if that is culturally appropriate with them because they had different backgrounds. Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.We had 3 parenting workshops at FirstStepNYC, and every workshop had a different topic. Workshop flyers were posted at FirstStepNYC 2 weeks before the workshop, informing parents the topics and time of workshop. Attending workshops was not mandatory. Parents were totally free to decide whether or not go to the workshops. If they had any reason had to leave during the workshop, they were free to go. The workshops were conducted in a comfortable area. People had enough space to sit down, and coffee, tea, fresh fruits, and snacks were offered for parents attending the workshop. All the parents were treated fairly, respectfully, and without bias related to their age, race, and socioeconomic status. We made the workshops more like open conversations instead of lectures. It helped them to share their personal experiences and discuss their thoughts with us. At the end of every workshop, parents were given time to ask questions. Objective 5: Utilize informational technology when managing individual and families in the community.Confidentiality is one of the core duties of nursing practice. It requires nurses to keep clients’ personal information in privacy unless we have the consent to release the information from the client. Children’s electronic records were not available for us at FirstStepNYC. In order to protect client confidentiality, we asked permission before using the paper charts to collect information. After using them, our team members would double check if all the charts were there and sent them back as soon as possible. All the data we collected were filled in several folders and were kept by professor. Objective 6: Demonstrate a commitment to professional development. Taking this class helped me to see the community as a dynamic whole. Every community is different and has different needs, so constant assessment is required. Before this clinic, I knew only very little about Brownsville from the media. By talking with parents at FirstStepNYC and searching data online, I had a better understanding about the community. Community Health Nurses are working in the front line of community health care, and they get the first hand information about their patients. Those information can be used to identify health risk factors specific to the community, make the right health-related interventions, and implement health education and activities.Objective 7: Incorporate professional nursing standards and accountability into practice.During orientation, professor went through the professional nursing standards and accountability with us. I always use the nursing process of assessment, diagnosis, plan, implementation, and evaluation in my nursing practice. It helped me to give safe, competent nursing care. Objective 8. Collaborate with clients, significant support persons and members of the health care team.Family always plays a very important part in individual’s health. Parents are the main caregivers of their children at home, and they act as role models for their kids, so parent education is very important for both parents and their children to achieve best health conditions. Health education is a primary focus of community health nurses, and the holding parenting workshops gave us a good chance to educate parents in the community. The topics of the three parenting workshops were determined after we assessed and identified the community needs. In order to make the related health care services more accessible to them, information of available health care resources were identified and given during the workshops. Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.The clinic experience helps me to understand how economic, political, social and demographic forces affect the delivery of health care services in Brownsville. The social and demographic features of a community indicate the health risk factors of a community and the health care services they need. Health care costs a lot of money. A large portion of people from Brownsville is living in poverty, and a lot of them are uninsured and using Medicaid. They are highly depended on the public health services being offered in the community. When the economy is down, the health budget for the community declines, and it affects the quality of health care services in the community. In order to improve the delivery of health care services in Brownsville, health care providers have to work closely with local governors and educators because poverty, health, and community are inseparable.Kenn Vincent Kongyingyong, RNObjective 1: Demonstrate individual professionalism through personal behaviors and appearance.During our time at PS 41: First Steps, we wore scrubs and our white lab coats during days that we did not have parent’s workshop. During the days that we held our three parent’s workshop, we were tasked to wear business attire clothes and be prepared to answer any question that would be brought about. All of the information presented to us by our professors, staff, and parents were kept confidential and was not discuss outside of the center. Pre and Post conference took place at each session that we were at first steps. Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.The staff at PS 41: First Steps provided us ways to gather information about students and their families. We were able to access charts of each child and assess different aspects of their health. Each child in the center was measured for their height and weights and was recorded in their chart. Their BMI was also calculated in order to determine their risk for obesity and other disease that goes with having a high BMI. With the community in mind, each of our 3 presentation gravitated around the main health concern of the community. They are influenza vaccination, diabetes and weight management, and asthma. Each presentation was conducted in separate occasion, each of which had increasing amount of turn out of parents.Objective 3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the heath needs of individuals and families in the community setting. The 3 presentations that were conducted at PS 41: First Steps ensured that the parents are able to ask the presenters questions and concerns they have. Handouts were given in order for the parents to go along with what the presenters and enable them to go over the materials again. With the presentation taking shape as a conversation rather than a lecture, the parents were able to be comfortable speaking with the nurses and communicate their concerns.Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.The three presentations that took place at PS 41: First Steps centered on the needs of the population and preventative measures. According to data, the prevalence of diabetes and asthma is higher in this neighborhood compared to others. With this in mind, the parent’s workshops were centered on the questions that the parents have. With this in mind, the presentation was our tool of teaching parents the importance of staying healthy.Objective 5: Utilize informational technology when managing individual and families in the community.With the population around PS41: First Steps, research was conducted using various resources to obtain information about peoples health in the community. One of the tools that we use was the United States Census. When a family with children who is in high risk or already obese, the parents was notified and a private meeting would be held with the professor.Objective 6: demonstrate a commitment to professional developmentThe literature that was presented to the parents come from health organization that are trusted and some owned by the government. The CDC (Center of Disease Control and Prevention) was one of the main sources of handouts that were presented. After each presentation, we would have a post conference held to talk about how the class performed during the presentation. We ensured that all questions and concerned was answered and the information provided come from trusted sources.Objective 7: Incorporate professional nursing standards and accountability into practiceThe rules and regulations of PS41: First Steps was the basis of our behaviors and action during the clinical hours. All of the projects and presentation was presented to the head of the center first prior to initializing the project. All information and data gathered was kept on the chart, where workers of the center or nurses can only access it.Objective 8: Collaborate with clients, significant support persons and members of the health care teamEach group of student nurse that were presenting different topics ensured that the parents were given information about the topic, the resources they have, and the key points. We ensure that the presentation did not take upon a lecture setting but rather a conversation setting. This ensures that the parents are able to talk freely and do not feel that the parents are being lectured about their behaviors.Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.I believe that the area of Brownsville where PS 41: First Steps is located do not have the substantial health resources needed. There is only one hospital in the area, which is Brookdale University Hospital. There is no diabetes center and asthma specialist in the area. I believe the reason behind this is that the area is one of the low socio economic neighborhoods in the New York City area, which entails that there are lower amount of financial resources. But the area has high rates of diabetes and asthma, and center that specializes on this area is a must in order to keep the people of Brownsville healthy.Damion Mark, RNObjective 1: In the process of my health promotion teaching to the families and children at SCO First Steps, it was very important for me to handle their information in a confidential manner. I shared families’ information that was collected only to my colleagues that was providing teaching at the facility. I secured data in folders and secured it away from access to the public. I believe it’s imperative to be pro active in order to maximize my true potential. I was asking many questions to the faculty and staff about the day to day operation of the program and also I was open to new data from my professors. Preparing for my clinical site was extremely important reason being that, I had to lead a work shop on the importance of immunization and preventing the Flu. I researched pertinent information on the topic and also made Flyers and handouts. I made it my duty to complete all my assignment in a timely manner, during the semester my usually time to arrive at the center was 8:30 but the day of my workshop I arrived at 8:00 to prepare for the workshop. Many times during my clinical rotation I was eager to learn and I made it my duty to seek information from the directors, teacher, receptionist, office managers, home visitors and the parents. During our stay at first step I was actively assessing the children BMI by doing heights and weights, also playing with the kids by assessing their gross and fine motor skills. I attended all my clinical rotation and home visit that was assign to me.Objective 2: I used an assessment screening tool that contains several questions regarding my client functional health; in addition I use the most current physical data from the children charts. In the process of interviewing my client I use my Functional Health pattern assessment Screening tool which consists of questions covering developmental, emotional, cultural, religious, and spiritual influences on the client’s health status. My clients had to rate their answers using a rating scale Never, sometimes, often or routinely. For example, one of the questions asked is (religious or spiritual practices give meaning to my life). Then I record their responses using the scale mention prior. After asking the all the questions on the functional health assessment screening tool I was able to evaluate the areas of most concern to my clients and address the issues in details giving them recommendation to the specific areas of concern. The screening tool I used covers areas about the client physical also for the children weight them using a scale and measures their height then calculate their body mass index (BMI). Safety was very important to me in assuring that the children at first steps were safe. I had to assist in applying an ice pack to a child that had knocked the back of his head. Objective 3: I had to demonstrate trustworthiness to my clients and in order to do that I had to develop rapport with them and encourage myself to smile more often, which I think helped me to be more effective in communicating with the parents and children at first steps. I had to conduct a background check by the department of education and in doing so I had to respond to emails and also had written letters send to the authorities. I also made telephone calls to my professors and the Department of Education. Clients data was accurately handle and documented in their appropriate folders. Objective 4:During my clinical rotation I participated in three workshops, Immunization, Diabetes and Asthma. During the work shop I emphasize on the importance of getting immunized and taking the flu shots every flu season. I elaborate on the methods of preventing Diabetes which entails reducing weight, eating a balance diet containing fruits and vegetable and increasing exercise time. Also the methods of controlling asthma and preventing exacerbation, I gave out flyers and facts sheet with information about healthy foods and location where you can have easy access to them. Before every workshops I evaluated my clients by using a questionnaire about the topic in the workshop, then after the workshop I ask questions to evaluate the outcome of my teaching. Objective 5:In the process of collecting the children height and weight I utilize the principle of nursing informatics by calculating the kids Body mass Index BMI by using a computer generated application from the CDC website which allows me the opportunity to calculate the kids BMI. Client records was kept in file cabinets and were assess with permission from an authorize personnel. During the documentation of the kids BMI I ensure that the data was not in site of the public and the records was return in a timely manner. Objective 6: I had to construct a workshop on Immunization, Influenza flu shots and methods of preventing the flu. I utilize data from the U.S Department of veteran affairs dated September 2014, also I was able to generate current data from the U.S department of Health services center for disease control and prevention for the 2014-2015 flu season. I made it my duty to research pertinent data that will be resourceful to me and my client. I spend ample time study and researching new information. I’m willing to engage myself in providing my independent knowledge and skills to enhance the running of the community Objective 7:In the process of providing teaching and health promotion to the families I try to conduct myself in the most respectful and trustworthy manner. In doing so I was able to incorporate a trusting relation with my client. I handle their information in a confidential manner, I gave them the opportunity to be autonomous, I made show the teaching that was provide was not harmful to them, it was beneficence; my duty was to minimize harm and maximize benefits. I treated everyone equally; there was no injustice or prejudice in the process of providing teaching to the parents and the children. I was in alignment with the institution policies and respect their decision that they made with the parents and the kids. I believe that everyone must be accountable for their behavior and be willing to take every responsibility for them. I make it my duty to take be responsible for leading the parents in the teaching workshops and also providing teaching to the kids. It was very important to stay focus on the agency mission, which is to helps vulnerable New Yorkers build a strong foundation for the future. They get young children off to a good start, launch youth into adulthood, stabilize and strengthen families and unlock potential for children and adults with special needs, which guided me to provide the best teaching and health promotion information to the families at first steps. Objective 8: Effective Collaboration was essential in providing optimal care to the parents and Children. I had the opportunity to speak to all the directors and staff in relationship to gathering data for the project. I spent time listening and evaluating information. I was practicing yoga with the yoga instructor along with the children. The dental hygiene students and faculty had the opportunity to express the importance of good dental care and methods of preventing cavity. They collaborated with us to provide the families with data on good dental hygiene and will also be coming to the First Step routinely. The need of the client is our main goal; we listened to the voice of the people and were able to hear the areas that are of most concern to them and the most therapeutic method of providing care for them. It was important to identify the health care resources for the client, mainly because most are not aware of the resources available in their community. For example, the Brownsville & East New York Farmers Markets which provide fresh fruits and vegetable for the community, the Brownville recreation center – NYC parks & recreation and Brookdale Hospital etc. Objective 9: The Brownville Community is highly populated and there is a significant lack in resources, for example, there is only one Hospital Serving this community, there is no employment agency to provide assistance for unemployed families. Also there is a need for public Gym to facilitate the many families that can’t afford paid fitness center. Since many people are dying from diabetes in the community and weight is a major risk factor, therefore controlling weight by providing Fitness centers will eventually reduced the mortality cause by diabetes. The local politicians including the congressman, assemblyman and local business need to be solicited for funding to enhance and improve the infrastructure and overall functioning of the community. Marie Pierre, RNIntroduction: My clinical site for the fall semester is FirstStepNYC also known as SCO. It is a new early childhood initiative that opened in the fall of 2013 in Brownsville. It has welcoming classroom for children and warm and highly qualified teachers. It is a place for children and families to grow and learn together to prepare for Kindergarten and beyond. This program in collaboration with City Tech offers student like myself to actually go to community of needs where resources are scarce. This has open my eyes so much to being a community health nurse and realizing that there is much more work needed to be done in certain communities across the nation. There are nine objectives that have help in shaping my views and enhancing my awareness about the role of a community health nurse. Objective 1: Demonstrates individual professionalism through personal behaviors and appearanceOur clinical class meet on Tuesday at 8:30am. At the beginning of our clinical we had a meet and greet with the staff to get acquainted with them. I dress professionally by wearing scrubs in my favorite color and lab coat over it with city tech badges. This is a monitored place, and every one that walks in must sign in at the security desk. Before the any interactions with parents and workers we meet in group with the professor for pre-conference where we discuss previous events that took place and discuss the activity for the day. We usually are prepared because the professor email us via blackboard throughout the week. Our conferences are mostly about the different kind of workshops in progress, home visits, and setting up equipment for the following week. In post conference announcements are given letting us know what we need to work on as for the week and also an opportunity to discuss and share about each tasks assigned to us. Throughout the day, we maintain a positive affect by smiling because we work with kids and don’t want to frighten them. We work closely with them by measuring their BMI, height, weight, and all information are kept confidential to only staff and workers. Although we work with kids but there are valued as individuals and privacy is important to all whether they understand or not.Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. The professor is very well familiar with the place, which make documentation easier in regards to accessing the charts. Also the staff workers are very helpful in assisting us locating them by class numbers. We use the charts to gather date in order to complete BMI sheet, nutrition assessment tool that a nutritionist must review at the end for each students. We transmit information we obtain from assessing the students which goes on their record. Measuring baseline BMI for this semester and we will follow-up the next semester. We make a note of the children that are consider high risk so that we can discuss with the parent of that child a plan of action in relation to nutrition and diet. As for the children, we assess them in the gross and motor room that allow them to play to examine growth and development. When discussing health relating issue with parents, we use simple terminology because we want them to be able to understand and ask questions. We provide visual materials by showing a video of the happy dance that we did as a promotional media for workshops invitation. We emphasize the importance to practice hand washing precaution for all members of the family. Because first at first we are not doing bed side nursing, teaching is important. We do demonstration to show them instead of just given verbal information. All parents were given opportunity to participate and we ask open-ended questions so that they can further express any thoughts, ideas, they have in regards to the workshop or other health related matters. Our priority in this program is preventative care for high risk children in this community and their family.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 am familiar to the Brownsville area prior to doing my clinical there. I have much awareness about the population and it diversity mainly African American, Hispanics, West Indians background. Using appropriate communication skills is important. I am attentively listen to the parents as they express concerns, and using day to day language when appropriate. We take notes to address specific parents in need acknowledging the dynamics among them. We want parents to be able to understand and give feedback. Not only the parents but the teachers and other staff at FirstStepNYC. Also the professor is the first person I go to when I am not sure about information that a parent might ask. The interaction is more participative where we want them to speak about experiences as we learn together. As for the workshop, we have certain topics we discuss but we answer questions that are not related to health and bring the focus back to the main topic. I actively listen because I want to know what’s important to them and not what the nurses think is important. This environment foster trust which allow the parents to volunteering give information that help the team and I to plan better for next workshops.Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practiceFor this semester the main events that we focus on are the parent’s workshops. We have some home visits but the workshops are open to all the parents as they drop off their kids. We advertise early on the semester and we make announcements on a weekly basis. The plan is to teach about health topics (Flu shot, diabetes, asthma) that affects the community and discuss health maintenance for preventative measure. The environment is welcoming and friendly. We serve refreshments and healthy snacks. The positive attitude of the staff at First Step is amazing which help me to smile more because we not only interacting with parents but with children. It’s a non-judgmental gathering that is conducive to learning and discussing important matters of the community. We utilize screening tool to assess parents and acknowledge focus areas to work on. The clients voice is encourage in participation. We have an open door policy and want parents to feel comfortable asking us questions. The parent’s feedback and direct observation help us to evaluate their learning outcomes.Objective 5: Utilize informational technology when managing individual and families in the community.We use the resources that school here at FirstStepNYC has such a laptop and projector to show our videos for the workshops. We use radio in each room for dance activity. We maintain confidentiality by returning charts to their proper location after using them. We discuss within the groups only in conferences and meetings. We work with the staff and ask questions about the policy in regards to privacy. We ask to take pictures, because not every parents give consent for their information to be shared with the nurses or schools. Objective 6: Demonstrate a commitment to professional development. Using appropriate literature is important in planning care for the parents because we don’t want to overwhelm them with information and make things up as we go along. We focus on evidence-based research to help guide us in planning care. We want them to learn so we keep flyers, pamphlets to a minimum and try to explain in the simplest terminology. We share information obtain from the CDC, and encourage to use google and YouTube for more visuals to increase their awareness. We reference to our book using the Alliance for Health Model Community Assessment Tool (p. 77) that gave us the outline for our project that the facility can keep as a long lasting reference in the near future. I am very committed to providing the community with the best updated resources out there to help raise more awareness about the health crisis that this community face. This clinical has given ideas that I am considering going to the public officials for resolution. I am also aware of my preconceive notions that I may have before interacting with people in this community. I so glad I get to see this first hand and not let the stigma speak for me. Objective 7: Incorporate professional nursing standards and accountability into practice.Utilizing professional nursing standard into practice is key in nursing practice. The American Nursing Association is the guideline that all nurses should be using with the nursing process for collecting date, making assessment, creating intervention plan, implementation and evaluation of the progress. These regulation help me as a nurse to practice safe, competent, accountable care in my delivery to this community. I am learning about the policy and procedure at FirstStepNYC and to follow those protocol, complying with them to avoid confusion and complications. The parents and students safety is priority and I take my responsibility seriously. It is a pleasure for me to comply with agency’s mission which is getting the children with their family a good start that will strengthen them on many aspects (education, health, social, leadership) in the community.Objective 8. Collaborate with clients, significant support persons and members of the health care team.The family at First Step are key to helping us take care of the little one because they take care of them at home. As we work close with our professor, teacher, yoga instructor we always acknowledge the parents and assess their needs to provide appropriate teaching in those areas at the workshop (Flu, DM, and Asthma). We encourage parents to check with their PCP because we can only teach and need a physician to give the diagnosis. Therefore we make referrals to those in need. We discuss the importance of physical exam, medication adherence, flu vaccine, follow-up care. Letting them know that they have a hospital near but can always research for a specialist in close proximity (Downstate-asthmas specialist/allergy specialist, Diagnostic clinic) according to their needs. There is also a case worker at the facility that serve as an advocate for the parents that get home visit so we work with them in their plan of intervention for those parents. Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.There are so many factors that influence the community and the way we deliver care services in Brownsville. Socio economic status, political, social (aesthetics, not enough park, gym, and recreation center), and demographic. It is the most prevalent area for developing type 2 diabetes. Brownsville has a high morbidity and mortality rate which should be at top list for the nation, yet it doesn’t get as much attention as it should. Even with death rate this high the community has one clinic, and one hospital that serves it. The resources are far too scarce for such health related crisis. It feels more like an abandon area and there a need for the environment to change in order to promote active and encourage physical activity. Conclusion: I am encourage to bring this issues to local city councilmen that serve and represent this community to get the funds needed to build more clinics and other health related facility. It’s a challenge that will take time, but I’m willing to do as much as I can to see this becoming a reality in the community. ................
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