Running Head: CLINICAL REFLECTION 1 4 CLINICAL REFLECTION Clinical Reflection Ashleigh Jacquez Patty Hanks Shelton School of Nursing Clinical Reflection The clinical site that I am going to discuss is a local elementary school. There is a single school nurse that provides the care. The care that the nurse provides varies based on what is needed by the students when they come and see her. Examples of care given include assessment of physical injuries, administration of medication for both acute and chronic conditions, and making referrals when necessary. Referrals can be to primary care providers or specialists. The nurse also provides screening for issues including vision, hearing, and scoliosis. She may also provide screening for unusual circumstances, such as child abuse. The nurse also acts as a consult to the teachers and other faculty, giving advice and information when needed. She also discusses the kids’ health with their parents, and teaches the parents how to best continue care at home. Lastly, the nurse is a teacher to the students. She teaches them about their bodies and how they will change as they get older. She teaches them how to care for their bodies and how to care for their mental state. She fosters a sense of independence and autonomy, so that the kids can make their own decisions and can be confident when doing so. The nurse is also very important for mental and emotional health and is “integral to the academic success of the nation’s 74 million youth under the age of 18” (Willgerodt, Maughan, 2018, p. 232). The population that this service provides care for is primarily students. The school is pre-kindergarten to fifth grade. The kids can be aged anywhere from four to twelve years old. The school nurse can also provide care to the faculty if needed. The students mostly come from middle-to-upper class families. All ethnicities are represented in the school, but the population is mostly white. The most common illnesses that are seen by the school nurse are acute. Examples of this include the flu, strep throat, and undiagnosed “stomach bugs.” The nurse can give over the counter medications, but they must ensure to have all of the students’ allergies on file and confirmed to ensure no adverse events. Medications that can be given include Claritin, Tylenol, and cough drops. The nurse must double check the appropriate dosage, especially because this can vary for each student given the level of physical development. The nurse can give prescription medications, but must have a doctors’ orders and have to speak with the parents to confirm all of the details. Common indicated medications include ADHD medications, asthma medications, and insulin. However, school nurses are not able to administer narcotics regardless if there is a prescription. The nurse does do the three medication checks ...

1. Running Head: CLINICAL REFLECTION
1
4
CLINICAL REFLECTION
Clinical Reflection
Ashleigh Jacquez
Patty Hanks Shelton School of Nursing
Clinical Reflection
The clinical site that I am going to discuss is a local
elementary school. There is a single school nurse that provides
the care. The care that the nurse provides varies based on what
is needed by the students when they come and see her.
Examples of care given include assessment of physical injuries,
administration of medication for both acute and chronic
conditions, and making referrals when necessary. Referrals can
be to primary care providers or specialists. The nurse also
provides screening for issues including vision, hearing, and
scoliosis. She may also provide screening for unusual
circumstances, such as child abuse. The nurse also acts as a
consult to the teachers and other faculty, giving advice and
information when needed. She also discusses the kids’ health
with their parents, and teaches the parents how to best continue
care at home. Lastly, the nurse is a teacher to the students. She

2. teaches them about their bodies and how they will change as
they get older. She teaches them how to care for their bodies
and how to care for their mental state. She fosters a sense of
independence and autonomy, so that the kids can make their
own decisions and can be confident when doing so. The nurse is
also very important for mental and emotional health and is
“integral to the academic success of the nation’s 74 million
youth under the age of 18” (Willgerodt, Maughan, 2018, p.
232).
The population that this service provides care for is
primarily students. The school is pre-kindergarten to fifth
grade. The kids can be aged anywhere from four to twelve years
old. The school nurse can also provide care to the faculty if
needed. The students mostly come from middle-to-upper class
families. All ethnicities are represented in the school, but the
population is mostly white.
The most common illnesses that are seen by the school
nurse are acute. Examples of this include the flu, strep throat,
and undiagnosed “stomach bugs.” The nurse can give over the
counter medications, but they must ensure to have all of the
students’ allergies on file and confirmed to ensure no adverse
events. Medications that can be given include Claritin, Tylenol,
and cough drops. The nurse must double check the appropriate
dosage, especially because this can vary for each student given
the level of physical development. The nurse can give
prescription medications, but must have a doctors’ orders and
have to speak with the parents to confirm all of the details.
Common indicated medications include ADHD medications,
asthma medications, and insulin. However, school nurses are
not able to administer narcotics regardless if there is a
prescription. The nurse does do the three medication checks
seen in the hospital for prescription medications. A common
chronic illness that is seen in these settings is type one diabetes.
In this scenario, the nurse works very closely with the students’
parents to ensure that the blood glucose levels of the student are
within expected range throughout the day, starting with the first

3. reading at home. During my clinical, I observed the nurse
administer insulin before student went to lunch. The student
was able to do her own glucose reading. After showing the
nurse the reading that the student obtained, the nurse figured
out the amount of insulin needed and prepared the insulin pen.
She then asked another faculty member to check the dose, and
then administered the insulin into the student’s abdomen. The
nurse then texted the student’s mom and let her know the
reading and the administered dose. Later in the afternoon, the
same student experienced a hypoglycemic episode. The nurse
had the student sit down and she gave her a snack, and then
rechecked the blood glucose reading again 15 minutes later. Her
reading was then within normal limits.
This school is funded by the parents of the students, who
pay tuition for the students to attend. The school is nonprofit
and they use the money to improve the school environment and
pay for student experiences such as field trips.
Overall, I enjoyed my clinical rotation and was able to
observe the nurse perform plenty of interventions. I was able to
do some vision and hearing screenings for the younger kids. It
takes patience and understanding to work with children,
especially with those who are so different in age and
developmental levels. The nurse must be very knowledgeable
about the different physical and health expectations for each age
group in order to intervene when it is necessary. The nurse
displayed great relationships with her students and I’m glad I
was able to observe someone who cares very deeply about her
job and those that she takes care of.
Reference
Willgerodt, M, A., Brock, P. D. M., & Maughan, E. D. (2018).
Public School Nursing Practice in the United States, Journal
of School Nursing, 34(3), 232-244.
http://eds.b.ebscohost.com.ezproxy.hsutx.edu:2048/eds/det

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Review the Institute of Medicine's 2010 report "The Future of
Nursing: Leading Change, Advancing Health." Write a 750-
1,000 word paper discussing the influence of the IOM report on
nursing practice. Include the following:
1. Summarize the four messages outlined in the IOM report and
explain why these are significant to nursing practice.
2. Discuss the direct influence the IOM report has on nursing
education and nursing leadership. Describe the benefits and
opportunities for BSN-prepared nurses.
3. Explain why it is important that a nurse's role and education
evolve to meet the needs of an aging and increasingly diverse
population.
4. Discuss the significance of professional development, or
lifelong learning, and its relevance in caring for diverse
populations across the life span and within the health-illness
continuum.
5. Discuss how nurses can assist in effectively managing patient
care within an evolving health care system.
Prepare this assignment according to the guidelines found in the
APA Style Guide. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.
RUBRIC: Summary of the four messages outlined in the IOM
report is clearly presented. A detailed explanation of why these
are significant to nursing practice is presented. A strong
understanding of the IOM report and its influence on nursing
practice is demonstrated.

5. The direct influence of the IOM report on nursing education and
nursing leadership is thoroughly discussed. The benefits and
opportunities for BSN-prepared nurses resulting from the IOM
report are described in detail. Overall, an in-depth
understanding of the IOM report and its influence on nursing is
demonstrated.
A thorough explanation the importance of the evolution of the
education and role of the nurse to meet the needs of an aging
and diverse population is presented. The explanation
demonstrates a clear understanding of the role of the nurse in
meeting the needs of an aging and diverse population.
The significance of professional development, or lifelong
learning, and its relevance in caring for diverse populations
across the life span and within the health-illness continuum is
discussed in detail. The relevance of professional development
in caring for diverse populations across the life span and within
the health-illness continuum is demonstrated.
A through discussion of how nurses can assist in effectively
managing patient care within an evolving health care system is
presented. The discussion offers compelling rationale and
demonstrates insight into managing patient care within
contemporary health care.
Thesis is comprehensive and contains the essence of the paper.
Thesis statement makes the purpose of the paper clear.
Clear and convincing argument that presents a persuasive claim
in a distinctive and compelling manner. All sources are
authoritative.
Running head: CLINICAL REFLECTION 1
CLINICAL REFLECTION 8Clinical reflection
Pavitha Paul
Patty Hanks Shelton School of Nursing
Clinical reflection
Home health nursing is different from inpatient settings
as in the nurse visits the patient at their residence to provide

6. optimal care. Home health services are extended to patients
disregard of their living conditions, socioeconomic status, race,
color, employment or education.an important point to note is
that they must be homebound in order to receive home health.
Nurses visit the patients wherever they are, which even includes
hotels, nursing homes, state school or hospice. The service
usually covers a radius of 70-80-mile. The normal case load is
about twelve. They do routine visits, twice a week or daily
visits. They provide services like supplying medical
equipment’s, medications, assessments of patient and living
conditions optimal for patient health, education on medication
adherence and health monitoring. They provide end of life care
to patients as well as their family members. They also provide
bereavement services. If the patient is young, they start it early
in order to help family with better coping.
The population of clients the home health services serve are all
patients who have 6 months or less to live or patients with
chronic illness that are homebound. They reevaluate the client’s
90 days after the end of the 6 months period and then every
other 60 days. The physician determines if the client is eligible
for hospice and thereby home health. Hospice is care provided
to terminally ill patients and once the symptoms of the disease
are under control, they can live in their residency to promote
more independence, privacy and comfort. As mentioned earlier,
care is provided disregarding age, gender, color, ethnicity,
socioeconomic background or education. The population mostly
enrolled for this service are older adults above 65 years who are
homebound with chronic illness.
Nurses visits the patients at their residency, does a physical,
emotional and home assessment. They check vitals,
prescriptions, ask pertinent information such as bowel habits,
urination, intakes and outputs and so on. They even fill the
medication/pill box ahead for two weeks. This helps the client
with medication adherence, having difficulty memorizing all the
meds and it also saves time.
The health-related problems the nurses at this service mostly

7. see are end-stage cardiac diseases, cancers and end-stage
respiratory diseases. The main goal of the nurses is to continue
medications as prescribed and provide as much as end of life
support. These patients are brought back to inpatient hospice
when symptom management at home is not possible or there are
IV medications needed which cannot be managed at home. The
interprofessional team consist of nurses, case managers, social
workers, nurse practioners or family doctor or hospice
physicians, physical therapist, occupational therapist, speech
therapist and pharmacist. The patients also get services like the
chaplain, volunteers (to read, cook at home, help with
groceries), aid services (bath, linen change, groom) and sitters.
They sometimes do team visits.
The home health nurses are on a 24 hour on call when
scheduled. Their working routine involves the following:
checking the assigned patients’ diagnosis and needs, preparing
meds and supplies to take for the clients, driving to their
location and providing the necessary care. An average time the
nurse takes to provide care is about 30-40 minutes. They have
standing orders in place such as meds for constipation (enemas,
milk of mag, laxatives), breathing treatments (albuterol,
prednisone nebulizer), anxiety (lorazepam), nausea and
vomiting (Zofran, Haldol), dry mouth (mouth wash) increased
secretions (atropine drops) and wound care. They also teach
caregivers about safety and check if they are compliant.
Home care services can be paid directly by patients and their
families or through a variety of public and private sources.
Sources for home health care funding include Medicare,
Medicaid, the Older Americans Act, the Veterans
Administration, and private insurance. Majority of the funding
is from Medicare and then third-party insurance. Home health
services is funded by the state.
There are some ethical dilemmas involved in home health
nursing. As stated in the journal, “Four main ethical concerns
emerged from the interviews with the visiting nurses who care
for older people in community-based settings: quantitative

8. performance rather than quality care, clients being invisible,
tuning the level of the relationship with clients, and facing the
visiting nurses’ own limitations” (Choe, Kim & Lee, 2015).
This means that the service provided should not be based on the
number of clients a nurse visits a day but instead the quality of
care that the nurse provided. There are instances when it is not
just patient centered care, but family centered. As the client is
at home, the nurses need to acknowledge the family’s needs as
well. It can be emotional or even decision making. It would be
safer for nurses to have a tracking device or technologies like
that for their self-protection. Some of the places are very
secluded and has bad neighborhoods. This might ensure that the
nurses are safe and has means for safety under emergency.
Reference
Choe, K., Kim, K., & Lee, K.-S. (2015). Ethical concerns of
visiting nurses caring for older people in the
community. Nursing Ethics, 22(6), 700–710.
https://doi.org/10.1177/0969733014542676