IPC Wyndham Community Health Centre: A Reflection Essay.

Demonstrated an in-depth reflection on an incident; personalisation of concepts &, theories presented in the course. Interpretations are insightful.

Implications for future nursing practice are thoroughly detailed

Demonstrated a general reflection on an incident; personalisation of concepts & theories presented in the course. Interpretations are logical but might be lacking appropriate depth. Some implications for future nursing practice are identified.

Demonstrated a minimal reflection on an incident; minimal personalisation of the concepts & theories learned in the course. Implications for future nursing practice section demonstrates gaps in understanding of the reflection process.

Demonstrated a lack of reflection on an incident; no personalisation of concepts and theories learned in the course. Identified implications for future nursing practice demonstrate lack of understanding of the reflection process.

Excellent expression and sentence construction. Discussion points are coherent & logical. Grammar and spelling always accurate.

Effective expression and correct sentence construction. There are no more than 3 spelling, grammar or syntax errors per page.

Basic expression & writing style. Grammatical and/or spelling errors but meaning still clear.

Poor expression; immature language & writing style. Grammatical & spelling errors distort the meaning.

Extensive, in-depth knowledge. All aspects of the topic addressed and concepts are exceptionally well linked. Strong evidence of critical thinking. Interesting, imaginative and relevant artefacts provided

Sufficient knowledge. All aspects of the topic addressed and concepts are linked. Evidence of critical thinking. A range of relevant artefacts provided.

Very basic knowledge. All aspects of the topic addressed but concepts are not always linked. More descriptive than analytical approach. Some basic artefacts provided.

Insufficient knowledge. Topic not critically analysed. Arguments are unclear and/or lacking logic in reference to theory. Incoherent. Either no artefacts or relevance of the provided artefacts not clear.

Part 1

Improving and Promoting Community Health (IPC) Wyndham is a local community health centre that provides healthcare to Wyndham Vale and its surrounding areas (IPC Health, 2018).  I had the privilege of undertaking a two-week community placement here at IPC Wyndham. Artefacts 1-22 presented shows the car park, main entrance, main reception, and IPC services and treatment rooms.

The integrated super clinic provides multidisciplinary services like counselling, general health, allied health, child, youth and family health. They also provide services like aged and disabled services, chronic conditions management, and health promotion along with needle exchange, and self-help and support services. General nursing, maternal health nursing, physiotherapy, social work, and General practitioner consultations (GP consultations) are also available (IPC Health, 2018) (9,11,13).

IPC Wyndham provides facilities like bulk billing, free interpreters and free immunizations especially for special population groups like children and refugees which promotes equity. ”Health equity is achieved by removing unfair and avoidable barriers that compromise health and wellbeing. The practice of health equity is focused on supporting fair access, fair chances and fair resources distribution to alleviate any disadvantage experienced by high risk or vulnerable groups”(Tasmania Government,2018). IPC Wyndham is accessible 8 hours a day and also provides home visits for its clients. They are also support many organisations which include the Western Health, Salvation Army, Wyndham City Council and  Better Hearing Australia (IPC Health, 2018). This is in line with creation of a supportive environment as per Ottawa Charter (2015). Support from large institutions like Western health enables them to deliver evidence-based practice to their clients (artefact 6).

Part 2:

  According to Duquesne University (2018), community nurses act as nurse educators, disease and injury prevention specialists, research scientist, community advocates, emergency preparedness experts, public health liaison and Healthcare professionals.

Kalosch and Aebersold (2016), noted that the registered nurse’s (RN) job is fast-paced as well as stressful, which is associated with multitasking and interruptions. Our educator at IPC Health also constantly multitasked and was frequently interrupted by team members and patients. In terms of her major role and responsibilities she delivered a safe, effective evidence-based nursing care, initiated and maintained a therapeutic relationship with patients. The nurse also practiced holistic a care which included patient's family, provided timely and accurate information to individuals and families to promote health, supervision and mentoring of nursing students, practiced within professional and ethical boundaries, and referred patients to appropriate services (Willging, Salvador & Kano, 2006). The educator also maintained care plans and health assessment guidelines, criteria, and requirements to ensure legal and ethical compliance. She maintained up to dated accurate database of care plans and health assessments including reviews and reminder systems (which are normally done by ward clerk in hospitals) (artefact 24).

Working as a nurse at IPC Health involves being an educator for the patients and also the nursing students (artefact 25-27). Our educator taught students to master areas like vaccinations safety checks, proper documentation of notes and reminding students that the notes were a legal document. Papastavrou et al (2010) in a study which was done in Cyprus, found out that even though in hospital, students were mentored in larger group model, the ones who reported to be more satisfied with educator's mentorship were the ones with a personal mentor. Nursing and Midwifery Board of Australia (2018), states that nurses under the domain of professional integrity are expected to commit themselves to teaching, supervising and assessing the students and other nurses in order to develop the nursing staff across all area of practice. The nurses always maintain privacy by always closing treatment room’s doors and curtains (artefact 22).Educating patients to manage their own chronic conditions is known as patient empowerment which is needed in healthcare. Caughey et al (2008), found out that Chronic conditions are a major burden to health and they cause disability. The prevalence of comorbidity is high in 80% of elderly population having 3 or more chronic conditions.

IPC Wyndham Community Health Centre

The IPC Health RN practised wound dressings and reviews. Patients came in with chronic wounds especially diabetic patients. Once our educator had to prepare the patient for sutures stitching similarly to a theatre nurse. The nurse at IPC Health is part of a multidisciplinary team, and we observed her often consulting other nurses for a second opinion and she also worked closely in liaison with a GP. Neumann et al (2010) noted that the basis for good team working includes agreed aims, agreement, and understanding on how to best achieve these. A multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and skills and expertise is expected to speak openly.

According to Muntean, Tomita and Ungureanu (2013), there are responsibilities for health promotion, directly through education designed to help maintain health. By providing the necessary care for re-establishing it, and indirectly by promoting respect towards human dignity this can be carried out. In Romanian studies, they found out that the more the nurses in an area, the fewer the rates of patients’ deaths. Our educator taught the patients the benefit of following a good diet, exercising and regular check-ups, and as expected, the compliant patients were the ones who always had a positive outcome (Debesay et al., 2014). One of the health promotions was the distribution and education of the utilisation of condoms and educational free brochures (artefact 15).

Muntean et al (2013) argued that Health was defined by UN as a "Physical, mental and social complete wellbeing". IPC Health nurses provide holistic approach to care by providing sporting and art opportunities for the children to keep them active, and household items for refugees and struggling families helps in alleviating patients’ stress (artefact 28,).

 Our educator administered free immunizations for children and refugees. Looking after the medication stock also requires checking the fridge temperature every shift and notifying supplier of the vaccines for further instructions if the fridges break down (artefact 20, 23). It is the nurses' sole responsibility to check children's immunization history from their history book, history of their visits to the doctor or on Australian immunization register (IPC Health, 2018). IPC Health RN always double checked the vaccines with a doctor or another nurse before administering it. Australian Nurses and Midwifery Federation (ANMF) Victoria Branch (2018) stipulates that all intravenous, subcutaneous, epidural, intrathecal, and schedule 8 medication for inpatients, prior to administration should be checked by two authorized personnel before administering.

According to Hughes et al (2008), community nurses must maintain a safe practice environment which reflects compassion and vigilance for the patient’s welfare that is important as any other aspects of competent health care. The RN educator maintained a safe environment by safe disposal of sharps and clinical waste and maintaining standard precautions. The RN’s duty included stocking up doctors’ rooms, drugs in emergency trolleys and safely disposing expired drugs, and ordering drugs from the pharmacy. (artefact 16,19,23,24).

The nurse also performed venepuncture (artefact 15) mostly done by pathology staff in hospitals and cleaned doctors treatment rooms which is mostly done by cleaners in hospital. She also undertook patient’s reminders which are the receptionists’ and ward clerks’ job in hospitals (artefact 24). The preceptor not have fixed patient workload like 4-6 patients per nurse as done in hospitals (IPC Health,2018). This is in direct contrast with RNs’ roles in aged care facilities. According to Australian College of Nursing (2016), aged care facility nurses delegate the cleaning jobs and activities of daily living (ADLs) to personal care staff and also delegate medication administration to enrolled nurses. There are also similarities between aged care RN and community RN like accountability, and clinical decision making among many others.

Multidisciplinary Services

The preceptor also delivered culturally safe practice to the patients (artefact 30).The Aboriginal and Torres Strait Islander clients who come to IPC Health also had access to the elder's lounge, a culturally safe drop-in space where the patients and their families meet with Aboriginal health team. Castro (2009) noted that culturally competent care leads to negotiations, mutual exchange of information, increased compliance, and improved patient-provider communication. Patient satisfaction with care is associated with increased compliance and greater continuity of care.

According to Debesay (2014), community nurses face a lot of challenges the fear of making mistakes and crossing boundaries related to the cultural and religious practices of minority patients, and also faced conflicting beliefs because nurses believe that the patients must start walking as soon as possible after a stroke to speed up rehabilitation while their relatives favour them to have extended bed rest. On the other hand, the relatives test the transparency of the nurses by asking nurses not to disclose the true diagnoses from terminally ill patients. This was vocalized by our educator that home visits might be quite challenging sometimes. We also remember to take stipulated breaks when we are working on the floor to avoid burnouts.

Despite challenges the IPC RN were happy to see the happiness of their patients and developing the careers of the students and flexibility of their working times (IPC Health,2018). Cheater, Ford and Leese (2009),noted that two thirds of the community nurses  where generally happy with their roles. However it is the role of the health provider which maintain and improve working environments which they require otherwise they can lose them prematurely.

Finally in terms of IPC Health, the RN performed diagnostic tests like ECG, pap test (artefact 15) for screening cervical cancer in women’s health and diabetic education of clients. Wang, Hoy, and Si (2010) noted that in Australia, 124 new cases of diabetes were diagnosed during the follow-up period, and the incidence rates increased with the increasing age. By the age of 60 years, cumulative incidence rates were 49% for Aboriginal men and 70% for Aboriginal women. They also found out that diabetes rates are higher in Aboriginal people. The lifetime risk of developing diabetes among Aboriginal men is one in two, and for women it is two in three.

It is clear that working as an IPC Health nurse is complex. It requires complete knowledge of mental health and human physiology and pharmacology. It also requires knowledge of legal and ethics associated with primary healthcare. The nurses possesse a lot of knowledge which helps the patients to avoid regular admissions into hospitals which decrease the cost of healthcare to the government and the patients.

Part 3

According to Hughes (2009), there is a growing awareness in Australia regarding issues that are faced by lesbian and gay people. They did a study of 371 people who are lesbian, gay, bisexual and transgender (LGBT) in conjunction with the Queensland Association for Healthy Communities. The finding of the study highlighted that a majority of the lesbians and gays were concerned about their sexual orientation and gender identity thus affecting the quality of the services received. Many also expected to be discriminated against and were concerned that same-sex relationship would not be recognized and that staff would not be aware of LGBT issues. Among other findings, gay men were more likely than lesbians, to be alone in later life whereas lesbians were more likely to be concerned about a lack of LGBT specific accommodation and lack of recognition as same-sex partners.

Health Equity

IPC Health recognizes LGBT patients as they have a rainbow flag which is on their reception desk (artefact 29). One of the nurses at IPC told the nursing students that they used to have a big rainbow art work painting, but they were asked to remove it by an LGBT organization. For them to get a rainbow tick (LGBT accreditation), every staff member needs to undergo an LGBT course which the organization offers. Some of the IPC Health nurses did the training but some still have to do it. The consensus was that the organization was just being unfair and were just concerned about getting money from them than LGBT patients' welfare.

IPC Health also supports the LGBT patients by participating in annual events which celebrates the LGBT people. In 2017, they participated in LGBT commemorations as in article (artefact 31) and IPC Health celebrated International Day Against Homophobia, Intersexism & Biphobia between 14 May and 17 May across all its campuses (artefact 31).

LGBT community belongs to almost every race, ethnicity, religion, age, and socio-economic group. The LGBT youth are at high risk of substance abuse, depression, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare provider’s awareness, and insensitivity to the unique needs of this community (Muacevic & Adler, 2017). At IPC Health, they run LGBT staff training twice a year and they provide rainbow ribbons to staff (artefact 31). This training emphasizes the importance of healthcare delivery to the LGBT population because nurses need to deliver health according to an individual which is person-centered care. IPC Health also supported LGBT Clients by supporting the yes vote for the marriage equality referendum which took place in Victoria (artefact 32).

According to Rutherford (2012), the problem is that all healthcare  providers self identify themselves as members of the LGBT communities, however most of them agreed that this membership was not to provide supportive, appropriate care for  LGBT individuals, Providers described  their self-identity as  members of the LGBT communities, associated  lived experiences and  recognition of the need for mental health services that are sensitive to the unique needs for of LGBT individuals as influential factors in their career decisions. The lack of training opportunities and resources specific to the recommendations included the introduction of mandatory LGBT curriculum. This helps in addressing the basic LGBT-related terminology appropriate interview questions to facilitate the disclosure of sexual orientation and gender identity information. This is in regards to the health impact of gender heterosexism, homophobia and specific care needs of sexual and gender identity minority people.

According to Lancet Global (2014), there were about 81 jurisdictions which criminalised consensual sex between two adults of the same sex, 38 of them being in Africa. Homosexual is a capital offence in 5 countries. Although we acknowledge the effort made by UN member states to help address the health of LGBT people, member states must prioritise the safeguarding of the human rights of vulnerable LGBT populations. A coordinated response is also needed by all interested parties including WHO, UN member states, service users, caregivers and civil society groups to condemn discrimination on the grounds of the gender or sexual identity. Healthcare workers must also engage with governments to remove any discriminatory laws and policies that have detrimental impact on LGBT population health. Brewer (2014),argued that some scholars noted that the use of the terms gay rights, gay marriages, same sex marriages and homosexual marriages may in itself carry implications for opinion and can alter the intensity of opinions expressed.

Supportive Environment

It is good that IPC health supports LGBT clients because many clients are afraid to approach healthcare facilities due to stigma associated with being a LGBT person. Mercedes, Driscoll, Kyle and Gray (2017) noted that many older adults came from an age during a time when homosexuality and many gender nonconformity were criminalised and many have remained invisible. Movements for social acceptance only started in the 1960s together with the civil rights movements, and it was only in 1973 when the American Psychiatric Association ceased to designate homosexuality as a disorder and not until 2015 that same sex marriage became legal nation-wide in America. As a result of the history LGBT older adults (over 50s) there is risk of significant mental and physical health disparities. They have higher rates of anxiety, depression, and substance use disorders and also at increased risks of certain medical conditions like obesity, cancer and HIV compared with heterosexual similar aged population. About 13% from 60-91years have attempted suicide. In another study they found out that the prevalence of excessive of excessive alcohol use, smoking and high-risk sexual behaviours is higher in older LGBT populations compared to non LGBT older adults (Ard &Makadon, 2012). LGBT older adults are more likely to avoid or delay healthcare or hide their sexual or gender identity from healthcare providers and/or social services personnel due to fear of discrimination. In order to deal with all the problems Mercedes et al, (2017) recommended incorporating the patient’s perspectives and experiences, seeking to understand their perceptions of positive and negative aging and attending to the social contexts of the patient’s lives in clinical practice. Above all they emphasize that LGBT older adults must be treated with dignity, while giving due consideration to their unique backgrounds and social experiences. The change begin at the individual provider level like IPC Health. So IPC health must be applauded for educating their staff about LGBT health issues, participating in equal marriage campaign for LGBT Yes vote in Victoria and treating everyone with dignity because all this comes from the fact that there is a realisation that something need to be done to improve LGBT health (Brewer,P.R.(2014).

According to Ard and Markadon (2012), the factors that bind the LGBT population are common experiences of stigma, discrimination, living at intersection of culture background and trying to be part of each other. LGBT people face a common set of challenges in accessing culturally competent health services and achieving highest possible level of health. They noted that providing culturally competent care to LGBT people is not different from anyone else. It only requires clinicians to understand their cultural context, modify practice policies and environments to be inclusive, take detailed and non-judgemental histories and educate themselves about health issues important to their patients. This will ensure LGBT patients and other patients to attain highest possible level of health.

Part 4

Context and detail of the situation

During the second week of placement at IPC Health at around 12 mid-day a female patient around 70 years old with a history of COPD arrived at the clinic with shortness of breath (SOB). The buddy nurse and I asked the other patient to excuse us a bit because we had to take care of something, which had occurred unexpectedly. We apologised and asked the other patient to wait for a while in the waiting room in order to maintain some privacy of other patient.

Part 2

We took the vital signs after gaining consent from the patient. When we did PQRST pain assessment, we discovered that she was experiencing chest pain. The doctor came and ordered us to perform an ECG which we had already started. It took a bit longer to connect ECG. The dots where not sticking properly we had to use sticky tape to keep them on the skin. The ECG machine also gave us problems after turning it on it was not working properly. The other nurse had to change ECG leads for it to work. After all these issues the other nurse began to panic. On top of the anxiety from the heart attack and not aware what the ECG was for the patient began to be stressed also. The doctor also recommended the patient to go to emergency department in hospital which the patient did not like.

I got worried about the nurse’s panicking. I thought we should be concerned about reassuring the patient that everything was going to be alright to decrease anxiety since the patient was already worried because of heart attack she was experiencing. However she being one of my teachers I felt that it was improper to bring it to her attention that her conduct was making the patient more worried. I didn’t want to give the patient the thought that probably we didn’t know what we were doing.

Later we spoke to her about the issue and she was surprised with the fact that students thought she was panicking which was causing the patient to panic more. She apologised about the event and she noted that if such incidents were to happen in our careers, we should ask consent, stay calm and explain the procedure to the patient.

My placement taught me to always seek consent from the patients, I also learnt look at legal implications of my actions and to be a member of a team. According to Ulrich et al, (2010) everyday ethical issues can attract little attention but can cause a lot of stresses to nurses. They noted that the five most stressful ethical issues affecting nurses and patients were protecting the patient’s rights, autonomy and informed consent to patients, staffing patterns, advance care planning and surrogate decision making. Other common experiences were unethical practices of health professionals, breach of patients’ privacy and confidentiality. Younger nurses and those with fewer years experienced higher level of stress and those from different religious background experienced specific type of problem more commonly. They concluded that nurses face ethical challenges in the provision of care. To retain nurses targeted ethics related interventions that address caring for increasing complex populations are needed.

Impact on my future career.

In future I will practice person-centred care. I thought the reason why the nurse forgot to get the consent was that the focus had diverted from being focused on the patient to focusing on the ECG machine which was giving us problems. In community nursing I learnt that being part of a team is beneficial to professional development. I learnt a lot of other things my buddy did not get an opportunity to tell me from other nurses, or to do the same thing she had taught me in a different way, sometimes ways easier to ways I had been taught to do before.

References

Ard,K.L.,&Makadon,H.J. (2012) IMPROVING THE HEALTHCARE OF THE LESBIAN,GAY,BISEXUAL AND TRANSGENDER LGBT PEOLE:Understanding and eliminating and Eliminating Health Disparities.The National LGBT Health Education:Boston

Australian College of Nursing.(2016) The role of registered nurses in residential aged carefacilities.Australian College of Nursing.Retrieved from:https://can.edu.au/wp-content/uploads/2018/02/therole-of-the-rn-in-residential-aged-care-pdf

Australian College of Nursing.(2018)Immunisations for Health Practitioners,Australian College of Nursing. Retrieved from: https://www.acn.edu.au/education/immunisation/immunisation-for-health-practioners.

Brewer,P.R.(2014)Public Opinion About Gay Rights and Gay Marriage:International Journal of Public Opinion Research,26(3)279-282.https://doi.org/10.1093/ijpor/eduo29

Caughey,G.E.,Vitry,I.A.,Gilbert,A.L&Roughead,E.E.(2008)Prevalence of comorbidity of chronic diseases in Australia.BMC Public Health,(8)221.Retrieved from:https://doi.org/10.1186/1471-2458-8-221.

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Duquesne University School of Nursing.(2018) Roles and responsibilities of community health nurse.Duquesne University.Retrieved from:https://onlinenursing.duq.edu/blog/roles-resposibilities-community-health-nurse/

Hughes,M.(2009) Lesbian and Gay People’s concerns about Ageing and Accessing Services.Australian Social Work,62(2),186-2001.

Hughes,R.G.(ed).(2008).Creating Safe and High-Quality Health Care Environments.An evidence Handbook for Nurses.Agency for Health Research and Quality:Rockville.

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Mercedes,Y.,Driscoll,M.D.,Kyle,J.,&Gray,M.D.(2017) Special Considerations in the Mental Health Evaluation of LGBT Elders.               American Journal of Psychiatry,12(5),4-6.https://doi.org/10.1176/appi.ajp-rj.2017.120503

Muacevic,A.,&Adler,J.R.(eds)(2009)Health Care Disparities Among Lesbian,Gay,Bisexual,and Transgender Youth:A literature Review.Cureus,9(4),1184

Muntean,A.,Tomita,M.,& Ungureanu,T. (2013)The role of community Nurse in Promoting Health and Human Dignity-Narrative Review Article.Iranian Journal of Public Health,42(10) 1077-1084.Retrieved from https://.ncbi.nlm.nih.gov/pmc/articles/PMC4436534

Nissanholtz,R.,Rosen,B.,&Hirsh,M.(2017)The changing roles of community nurses:the case of health plan nurses in Israel.Israel Journal of Health Policy Research,6(69).doi 10.1186/s13584-017-0197-5

Paez,K.A.,Zhao,L.,&Hwang,W.(2009)Rising out of pocket spending for chronic conditions:A Ten-Year  Trend.Health Affairs.Retrieved from:https://doi.org/10.1377/hlthaff.28.1.15

Paez,K.A.,Zhao,L.,&Hwang,W.(2009)Rising out of pocket spending for chronic conditions:A Ten-Year  Trend.Health Affairs.Retrieved from:https://doi.org/10.1377/hlthaff.28.1.15

Rutherford,K.,McIntryre,J.,Diley,A.,&Ross,E.L.(2012) Development of expertise in mental health service provision for lesbian,gay,bisexual and transgenger communities.Medical Education,46(9)903-13.Retrived from: https://www.ncbi.nlm.nih.gov/pubmed/22891911

Scherdel,L.,Martin,M.,Deivanayagam,A.,Adams,E.,&Thomas,S.(2014) The Search for International Consensus on LGBT Health.The Lancet Global,2(6),32.https://doi.org/10.1016/s2214-109x(13)70169-4 

Storey,C.,Cheater,F.,Ford,J.,&Leese,B.(2009)Retaining Older nurses in primary pare and the community.Journal of Advanced Nursing,65(7),1400-1411.https://doi.org/10.1111/j:1365-2648.2009.05009.x

Ulrich,C.U.,Taylor,C.,Soeken,K.,O’Donnell,P.,Farrar,A.,Danis,M.,&Grady,C.(2010)Everyday ethics:ethical issues and stress in nursing practice.Journal of Advanced Nursing,66(11),2510-2519.https://doi.org/10.1111/j.1365-2648.2010.05425.x

Willging,C.E.,Salvador,M.,&Kano,M.(2006)Unequal treatment:Mental Health Care for Sexual and Gender Minority Groups in Rural State.Psychiatric Services,57(6),867-870.Retrivieved from:psychiatryonline.org