My partner Napiela and I have been assigned to JASA NORC site Trumps United on Neptune Avenue. During the past two weeks, we achieved many goals with regards to the capstone project.
Our primary goal was to visit the clinical site to understand the actual safety needs of this community. Harris (2016) highlights that consideration for a project must ensure “readying the project environment by identifying and validating the need for the project, developing the plan, and obtaining system buy-in and/or approval from stakeholders” (p. 4). We visited the clinical site and met with our preceptor, Alla Acevedo, a registered nurse with experience in emergency medicine and community health. Although we communicated with Ms. Gottlieb, the director of the facility, we quickly realized that her suggestions, although well-intentioned, did not meet the needs of the facility. Our preceptor helped us to see that issues such as fall, depression, and isolation were issues that really faced the local community and would be a better focus for our project.
Another goal was to create a concrete schedule for visiting the clinical site. Harris (2016) states the importance to “identify expectations and the schedule needed to move the project toward completion” (p. 14). The past month was hectic with my work schedule and I was unable to be present at the site to start the project. The days that I was off from work were the days that my preceptor would not be present at the site. However, through open and frank communication with my supervisor, I was able to rearrange my work schedule in a way that allowed me to be present at the site with my partner to complete our project in a timely fashion.
Another goal was to concretely decide on our capstone project ideas and begin collecting data. “The identification of a need is the cornerstone for project planning and organization is starting a new clinical program or a community is considering enhancing existing services” (Jones & Roussel, 2016, p. 122). Nurse Alla let us know that diabetes was not a major issue facing the population at Trumps United. However, she identified many core issues facing the population in this retirement community. She spoke of how depression profoundly affects many of the residents in the community. Many clients will isolate themselves and limit their participation and socialization with others. This is related to their change in health status, distance between family members and friends, as well as conditions affecting their family members. For my project, I decided to screen clients for signs or risk factors for depression and create a workshop on how to combat depression for the geriatric population. In order to do so, I decided to do a quick assessment in office for the patients who visit in the nursing office. I would provide them with the geriatric depression assessment (short form) that has 15 questions in order to provide an initial screening of clients at risk for depression. My goal is to compile a list of patients who are high risk for depression, arrange home visits with them, and provide them with in-depth depression assessments and interviews. I would then compile the data and create a workshop that focuses on risk factors that personally affect the community and provide them with tools and resources to help combat depression.
The final goal was to identify which change theory to implement in my capstone project. Longo & Roussel (2016) state that “changing organizations for excellence requires a change in the ways that people think and interact to create workplaces and systems that are purposeful and are aligned with evidence-based results” (p. 132). The change theory that I believe best applies to my project and to the needs of this facility is Lewin’s Change Theory. Lewin’s Change Theory involves three steps: unfreezing, change, and refreezing. “Unfreezing focuses on the need to dislodge the beliefs and assumptions of those who need to engage in systemic alterations to the status quo” (Cawsey, 2016, p. 44). By identifying a quick and sharp need, the people in the system are now susceptible to the implementation of a change agent. Then after implementing this change, “refreezing” occurs in order to accept and keep these changes in their new form. With regards to my project, unfreezing occurred when the nurse highlighted the major issue of depression. Compiling data through initial depression screenings can help forcefully highlight the need for change in assessing in treating depression in this community. After completing these assessments, the depression workshop will be the change agent to shift the systems and encourage new ideas and conversations about depression in this community. Refreezing will occur by continuing depression workshops and buy referring the patients identified as high risk for depression to social services for continued evaluation and treatment.
The biggest challenge we faced was the language barrier. “Communication barriers are created when others do not comprehend the language, which then limits opportunities for mutual ideas and knowledge sharing” (Harris & Ward-Pressman, 2016, p. 104). The majority of residents in the community are Russian speaking with very limited understanding and use of English. Although many clients came into the office, there was a limited number of clients that were able to participate in the interview. To combat this challenge, we spoke with our preceptor who encouraged us to offer every person who came into the office a chance to participate in our interview. If they didn’t understand enough English to participate, she served as a translator for us.
Another challenge we faced was that the clients in the community were reluctant to participate. By the end of the first day, 17 clients came into the office but only 6 participated in our interviews. They were hesitant for many reasons. We were new and strange faces that they weren’t comfortable with, we were not Russian speaking, and some may have been uncomfortable with discussing the topic of depression. Again, our preceptor Alla was an immense help. Instead of asking for direct volunteers, she encouraged us to tell the residents that our project’s focus was to find information and strategies to better their community. We engaged in a lot of small talk and formed a great rapport with many of the clients. By utilizing this approach, we found many participants and prospective participants who promised to return next week to participate in our interviews. This helped me to “be cognizant of cultural differences” (Harris, 2016, p. 15). Culture we’ll play significant role in our capstone project because we will have to take the time to understand the culture of the Russian population and see how this impacts our data. Further, understanding the cultural differences between the Russian population and my own culture will help me to better understand their needs and create a project that is reflective of this population’s needs.
The final challenge that I faced was asking questions that may have been extremely uncomfortable for some seniors to respond. The geriatric depression screening-short form had in-depth and personal questions to ask someone that I had just met. It may have been uncomfortable for people to answer truthfully to questions asked by a stranger younger than them. Many clients scoffed or outright laughed at some questions, trying to indicate that these did not apply to them. Dearman, Styron & Whitworth (2016) emphasizes that "even if they are minimal, the researcher needs to address all risks and benefits to the participant, actual or potential, including physical or psychological risks and benefits, inconvenience, and loss of privacy” (p. 64). Therefore, to combat this challenge, my goal was to maintain a level of professionalism to convey the seriousness of the interview. I began by presenting a friendly aura and asked non-invasive questions to build a simple rapport with the client. I clearly identified the topic of my interview and ensured them that they were not obligated to participate. When one’s answers were negative or reflected a high-risk of depression, I made sure to communicate empathy and provide therapeutic touch in order to encourage the client to verbalize their feelings and emotions.
Utilization of Coaching and/or Mentoring
Ms. Alla was an amazing resource to us during the past two weeks. Firstly, she helped us to understand the facility and her/our role in the community. She discussed the various types of elderly populations with us, their concerns and needs, and how we can gear our project to reflect these needs. She provided us with practical suggestions such as ensuring that our in-office assessment is short in order to encourage maximal participation and to ensure that clients wouldn’t be fatigued with our initial questioning.
She also helped establish our presence in the nursing office by helping the clients to familiarize themselves with us. She introduced us to every patient that came into the office and even encouraged them to let us check their vital signs and participate in our project. Ms. Alla provided us with tactics to approach the seniors in the community by encouraging us to emphasize that our project’s focus was to find information and strategies to better their community.
Finally, she helped us through modeling behavior. She provided us with a model of our health information presentation that she had created in order to show us how to model our presentations for the community. She also took us on Home visits in order to model what a home visit should be like and help us to get comfortable being in a client’s home space.
Capstone Project Progress
Currently our project is moving at a great pace. First and foremost, we have both identified topics to focus on that are clear safety issues that require our focus and attention in this community. For myself, I will be focusing on the effects of depression in the geriatric population and how to combat them. In order to progress, I have begun extensive research on the Baruch Newman library about the effects of depression in the geriatric population as well as non-pharmacological treatment options available. Second, we have begone the data collection and fact-finding portion of our project. This has been accomplished by engaging the clients in an initial screening interview in order to begin compiling data on patients at risk for depression in this community. I hope that 3-4 days of initial screenings can help me to find a substantial sample of clients to identify for in-depth assessments. Third, we have identified what our final intervention will be which is creating a helpful workshop on how to combat against depression in the geriatric population which involves the creation and formulation of a health education workshop. We have spoken to our preceptor about completing these health workshops and have settled on a tentative time frame to implement this workshop. All in all, I’m happy with the progress that we’ve made. For starting so behind, we have really taken our project and run with it.
Leadership Lessons Learned
One of the most important things I’ve learned is how my emotional intelligence impacts my role as a leader. “Emotional intelligence may provide access to one’s own resources and is characterized by self-awareness, self-motivation to carry out tasks, creativity, and the desire to perform well” (Thomas, Roussel & Harris, 2015, p. 72). Being in tune with one’s emotional intelligence helps them to be a more effective nurse leader as they’re able to understand the emotions in themselves and help evoke emotion in others. Emotional intelligence and leadership where link together from me during this week at my clinical site. In my project, I’m handling a very emotional topic. Therefore, I had to really reconcile my emotions and feelings about depression in order to truly tap into the emotions of the people that I was surveying. I had to understand myself and my emotions so that I could better understand the emotions of others.
One major outcome that was achieved this week was visiting the clinical site and understanding the key safety issues impacting the community. The second outcome that was achieved was assuring that a clear topic and plan was formulated and implemented at the clinical site. The third outcome achieved was commencing data collection and research in the local community. This data collection will help me to achieve the final goal of identifying key risk factors for depression in the community.
Track Clinical Hours
COURSE: NURS 499 weekly log
ACTIVITY in clinical, plan for next week
Spoke to Evelyn Gottlieb, Director of JASA NORC to identify some safety issues at the facility
Researched information on Baruch Newman Library (CINAHL) about diabetes workshop as per suggestion of Ms. Gottlieb
Spoke to Professor about clinical instruction and research focus for capstone project
Encouraged to focus on link between diabetes and depression
Researched articles on Baruch Newman Library (CINAHL) concerning risk for depression in diabetic patients
Visited clinical site
Met preceptor Alla Acevedo RN and discussed care and safety needs of community
Identified safety issue: Depression/Isolation in Geriatric Clients
Researched various Geriatric Depression Screenings
Identified screening tool to be used in office visits(Geriatric Depression Screening-short form)/home visits (Geriatric Depression Screening-long form)
Researched articles on Baruch Newman Library (CINAHL) about depression in the elderly
Began screening patients in office using geriatric depression screen (GDS scale)
Screened patients at community party for signs of geriatric depression using GDS scale
Compile and analyze initial data-identify clients at risk of depression and collect information to engage in home visits
Observed two home visits with preceptor in order to develop and understand what the home visit process is like and to develop ideas on how to personally conduct home visits
NEXT WEEK: Will continue to screen patients in office for depression/form rapport with repeat visitors to encourage participation in project
Cawsey, T. F., Deszca, G., Ingols, C., & Cawsey, T. F. (2012). Organizational change: An action-oriented toolkit. Thousand Oaks, Calif: SAGE Publications.
Harris, J. L., Roussel, L., Walters, S. E., & Dearman, C. (2015) Project Planning and Management: A Guide for CNLs, DNPs, and Nurse Executives (2nd ed.). Sudbury, MA. Jones & Bartlett Learning.
Roussel, L., Harris, J., Thomas, T (2016). Management and Leadership for Nurse Administrators (7th ed.). Burlington, MA. Jones & Bartlett Learning.