Identify the clinical experience and describe the events noting four areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. Intake

JOURNAL

Identify the clinical experience and describe the events noting four areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. Intake:

The clients in luther Health Center are families facing challenges, such as poverty, violence, no insurance, unemployed, and inmates, undocumented immigrants, the homeless, the retired senior citizens, and the children without health insurance. Chronic care has always been the highest priority in the luther Health Center. Clients who have chronic diseases like diabetes and hypertension are given the best attention possible. Majority of the clients who attend the Open cities are lower class clients who have either high school or GED as their highest level of education.

The clinic does a good job on follow up. The medical assistants are very good at making phone calls and reminding their clients of the Doctor’s follow up. With the permission from the client and the provider, I had an opportunity to watch the interaction between the doctor and the clients. Four of the clients came to the clinic due to the recurring UTI. The clients raised their concern about the recurrent UTI which is bothering them. One of the patients told the provider about how she had taken all her medication as prescribed but the UTI is still bothering her. The provider instead ordered for a urine culture which came out to be positive and ordered stronger dose of the antibiotics. During my stay with the client, I never had the provider advice the patients to come back for a follow up three days after the antibiotic treatment. The provider never educated the clients about how some bacteria is resistant to certain antibiotics, and, about how they need to stay hydrated in order to flush the bacteria out of their system. Drinking plenty of fluid and staying hydrated would help the client to flush out the bacteria and make sure it does not stay in the bladder. She had little time with the clients. Lack of education is a great concern with the clinic. Since the clinic does not employ nurses, it is the role of the provider to educate the clients. The clinic does not use nurses, it instead uses medical assistants who do not have the license to educate the clients about taking all the medication as prescribed. I was able to interview a number of clients. Most of the clients had chronic illness like diabetes, hypertension, and mental illness to mention but a few. I interviewed a diabetic client who just came from Africa to join her husband who is a student. She raised concern for lack of medical insurance. I asked her whether she had talked to her provider about her lack of insurance. Her response was that “I do not trust the provider and the medical assistants. I overheard them talking behind another patient”.

This raised my concern. Lack of privacy and confidentiality can make communication very difficult between the patient and the provider. Respect for patient privacy and assuring patient confidentiality have been regarded as essential obligations of healthcare providers and primary responsibilities of healthcare institutions. I was able to inform the client about MNSURE which offers medical insurance at a subsidized price. The husband revealed to me that both of them do not have papers to enable them to apply for medical insurance. Public health care nurses face a lot of challenges and this is one of them. How do you refer undocumented immigrant to affordable care insurance when one of the requirements of getting that medical insurance is being an American citizen or permanent status holder?

During my interview with couple, I asked the wife whether she had any knowledge about diabetes. She told me that she was newly diagnosed and she did not have any idea how to control her diabetes. I provided some education about how to control her diabetes. I told her to get a note book, check her blood sugar every morning, and write the time and the blood sugar number in the note book indicating the day, date and the time the blood sugar was checked.

The wife was prescribed some medication which she could not afford. She was scared of coming for a follow up for fear of being deported. One of the important issues which hinder the community from seeking medical care is the immigration status. For some reason, the client was able to confide in me.

Lack of privacy may result in medical errors and, misdiagnosis for healthcare providers. Upon checking her vitals, her blood pressure was 150/80, pulse 89, oxygen 98 % RA and respirations 18. When the provider looks at her blood pressure results, she might diagnose the patient with hypertension. In the actual sense, the client had some underlying personal fear of having been diagnosed with diabetes, being not being able to control her diabetes due to unemployment and lack of education about the disease.

During my time at the clinic, I was interested in finding out whether patient’s privacy and confidentiality was and can be maintained in the clinic. I spent about 15 minutes in the patient waiting area.

References:

Lin, Y. K., & Lin, C. J. (2011). Factors predicting patients' perception of privacy and satisfaction for emergency care. Emergency Medicine Journal, 28(7), 604-608. doi:10.1136/ emj.2010.093807 (R)