DRAFT: This module has unpublished changes.

Blog Post #3: Week 7


Introduction/overview of week’s goals and accomplishments


During these past two weeks, Napiela and I have experienced many ups and downs with our capstone project. Progress has definitely slowed but hasn’t stopped.


One of our goals for these two weeks was to finish in-office assessments by 10/11/2018 in order to commence the home visit portion of our assessment. However, due to unexpected circumstances with regards to religion, we’ve had to add two more days of in-office assessment before we begin follow up in-home assessments.


Another goal was to continue attending home visits with our preceptor Nurse Alla in order to obtain the best strategies to complete our own home visits. Nurse Alla has been a transformational leader. “Transformational leaders motivate followers to perform beyond normal expectations by reshaping their thoughts and attitudes and by enlisting vital support of the vision while striving for its fulfillment” (Thomas, 2016, p. 90). Nurse Alla engages in role modeling with us because she shows us her approach in handling clients with professional, sincerity, and care. She is succinct in her questioning yet doesn’t leave the heart out of healthcare. Napiela and I spent one of our days accompanying Nurse Alla on her home visits to see her approach and tactics that helped the client feel comfortable with us in their home space. She also let us conduct home visits independently, helping us to feel comfortable in the home setting. In one home visit in particular, she let me take the lead with assessment questions and I was also able to conduct my assessment interview. By implementing her strategies and melding them with my own experience in healthcare, I was able to accurately assess a client’s extremely high risk for depression and suicide.


Finally, another goal was to develop rapport with the clients in the NORC to allow familiarity and participation in our program. We’ve begun developing a therapeutic relationship with our clients which is the cornerstone of nursing practice. A therapeutic relationship involves developing a trusting relationship where the client feels that their concerns and needs are being validated. Establishing a trusting client-provider relationship is essential and beneficial. “Pathways through which communication between clinicians and patients or families can influence health outcomes may be direct. For example, it can be therapeutic to talk with a nurse who validates the patient’s perspective or expresses empathy. This may help a patient experience improved psychological well-being: fewer negative emotions (e.g., fear, anxiety) and more positive ones (e.g., hope, optimism, and self-worth” (Benbenishty & Hannink, 2017, p. 208). It was important for us to develop a friendly rapport with the clients at Trumps United because we were new faces entering their home environment. Also, our role was to bring about a project for change, one that can be sensitive for people to talk about, especially with a stranger. During the past two weeks, we have seen some of the same faces. They are very friendly and engage us in conversation in order to learn more about us. This, in turn, has opened the door for them to communicate with us, not as students, but as clinicians. Some clients who only allowed us to check their pressure the first time have actively participated in our interviews. Many have promised to attend our health workshops.


Challenges (anticipated and unanticipated) faced and strategies used to overcome challenges/barriers


There were many unanticipated and anticipated challenges that we faced during these past two weeks. On Monday, 10/1/2018, we noticed a distinct lack of participants or even clients coming to get their routine blood pressure reading. We discovered that it was Shemini Atzeret, a Jewish holiday to honor their deceased loved ones. On that day, they “recite the Yizkor (memorial prayer) in the synagogue on the last day of Passover, on the second day of Shavuot, on Shemini Atzeret, and on Yom Kippur” (Goldstein, 2018). Many take the time to remain in the temple all day to honor their deceased loved ones. Due to this, we experienced a very low number of participants that day. Harris (2016) states how important it is to “identify and anticipate obstacles. Knowing what has been attempted previously to resolve a problem or opportunity can only benefit the present outcomes” (p. 14).  Therefore, to overcome this unforeseen challenge, we decided to add extra days to our in-office assessments in order to gather as much preliminary data as possible.


Secondly, participation remains a challenge. Many clients either ask for Nurse Alla directly or don’t give us the opportunity to ask them to participate. During this past two weeks, we have had minimal participation in our in-office interviews. In order to combat this issue, it was clear that we needed to institute a change in organizational culture. Missel & Thomas (2016) addresses the fact that “organizational culture and change in leadership as foundational to implementation of evidence-based practices and quality improvement, emphasizing the need to honestly assess the environment to leverage strengths (and champions), and to prepare for resistance or compliance proactively” (p. 192). Part of the organizational culture of this facility is that patients come in for routine blood pressure screenings, get the results, and leave. There is discussion about healthcare needs and medication management, but the conversation sometimes does not progress in a way that one can talk about deeper issues. Therefore, our organizational change involves normalizing the interview process. Our preceptor suggested that we make sure to offer the interview, even prior to the blood pressure check. This allows the clients to understand that these interviews are just as important as their blood pressure as it is meant to help them and their community.


Finally, the language barrier remains an ever-present challenge. The large Russian speaking population truly limits our ability to conduct interviews with them. They themselves don’t feel comfortable talking to us because they feel as if their English is too poor to accurately translate their information. This is a key dilemma in cross-cultural nursing and assessment. “When cultural and linguistic differences exist, they pose unique complexities for cross‐cultural health care research; particularly in qualitative research where narrative data are central for communication as most participants prefer to tell their story in their native language.” (Al-Amer, Ramjan, Glew, Darwish & Salamonson, 2018, p. 1151). Asking someone to relay personal information is difficult, but the added dsadvantage of language creates another barrier. However, to overcome this challenge, the social workers and nurses help us by encouraging Russian speaking patients to interview with us despite the language difficulties and by serving as translators during the interview process. I have also utilized the limited Russian that I know in conversation to help make the clients comfortable. In Russian, I introduce myself, tell them my name and that I’m pleased to meet them and that I’m learning their language so they feel less uncomfortable and the anxiety has been minimized


Utilization of coaching and/or mentoring


Nurse Alla continues to be a wonderful support in our clinical process. She gave us the sage advice to complete our assessment with all clients that come into the office in order to maximize participation. Further, Alla has taken us on home visits with her to help familiarize us with the process in order to complete our visits independently. She has modeled excellent behavior for us to follow during our home visits by remaining knowledgeable, open, and friendly-encouraging great rapport with her clients. Alla helps me to understand the importance of developing self-awareness, or “the ability to recognize one’s emotions, moods, and drives, as well as the as the effects on others” while still maintaining self-regulation, or “the ability to handle emotion so they do not interfere with project work yet to be completed” (Harris & Ward-Presson, 2016, p. 103). These abilities are really important for me to develop because I have such an emotional topic. Sometimes I can get swept away in the emotions of the conversation or of the client’s answer. However, it’s important to have self-regulation in order for me to realize that I should handle my emotions well enough to continue project work. Another activity that she has done is debriefing after the home visit. We discuss what the visit was like, the information gathered, and how we can improve with each following home visit. She also encourages us to document our relevant information in personal notebooks and on the computer immediately in order to retain a current log and table of the data we’ve received from the client. Finally, she continues to encourage hesitant Russian speaking residents to participate with us, allowing them to become comfortable with us.


Capstone Project Plan Progress


The capstone project is progressing slowly, not as much as we would like, but progress nonetheless. Due to the Jewish holiday, our preliminary data collection has been delayed. However, I will be continuing to assess patients in office using the geriatric depression screen (short-form), continue to develop a therapeutic relationship with theses clients, and will ideally begin home assessments on 10/29/2018. Secondly, I’m developing a list of questions and assessments for the home visit aspect. These assessments include a home assessment (observing the home for neglect/disrepair), physical assessment (odor, grooming, hygiene), and interview questions to identify depression risk factors and suicidality risk. Thirdly, I’m using this time to conduct more research into the project and beginning to formulate the health workshop presentation. I’ve found great resources on the Suicide Prevention Resource Guide website that provides staff and resident training for a retirement community setting on monitoring for depression and suicide.


Leadership lessons learned


During these past two weeks, I’ve come to examine my nursing supervisor’s leadership style and discovered my conflict management style. According to the Thomas-Kilman Conflict Management quiz, my highest scores were in accommodating, avoiding, compromising, and collaboration with my lowest score in competing. This shows signs of me being the less assertive person. Therefore, I have a collaborating style of conflict management. The collaborating style of conflict management includes “a combination of being assertive and cooperative, those who collaborate attempt to work with others to identify solutions that fully satisfies everyone’s concerns” (Walden University, 2017). Examining my conflict management style has helped me to examine what I would like to improve on as a leader. Although it is important to be a collaborative member of the care team, it is also important to command leadership and authority. Oftentimes, coworkers who are older than me will argue over assignments and workload, something they would never do with my brash charge nurse. I want to improve in my ability to command authority without acting overbearing or entitled.


Another leadership lesson I’ve learned this week is how transformational leadership works in action and how this leadership style can affect a team. “Empowerment of others, clarity and vision, and expectations of transformative change through the leadership teams generates synergy and creative possibilities not previously considered” (Thomas, 2016, p. 90) I’ve never dealt with a nurse leader or supervisor who actively practiced transformational leadership strategies. However, our preceptor is a great example of a transformational leader and her example has empowered us. By enabling us to be independent change agents in the facility, she encourages us to not only follow but lead through change.


Outcomes achieved

This week, we have made progress in our clinical project. We have continued preliminary assessments and screenings on older adults that have come into the office. Secondly, I have identified and prepared assessment tools to utilize for home assessments beginning on 10/29/2018. Finally, I have begun preparing the health workshop presentation and have sat with activities director to get our health workshop put on the calendar of activities for mid-to-late November. Although language and participation remain barriers, we remain hopeful and will try different tactics to overcome these challenges. All in all, we will continue and hope that the next two weeks bring even more progress. 




Track clinical hours weekly / running total














Continued screening patients in office using geriatric depression screen (GDS scale)

Compile and analyze initial data on Excel table-identify clients at risk of depression and collect information to engage in home visits

Identified/Prepared assessment tools to utilize during home assessments




Researched articles on Baruch Newman Library (CINAHL) about depression in the elderly

Researched articles concerning loneliness and isolation in retirement communities

Engaged in research about mental health/suicide in the older adult




Researched CDC, WHO about mental health in the older adult & depression in the elderly

Identified training resources and certifications for preventing suicide in retirement communities as identified on Suicide Prevention Resource Guide





Continued screening patients in office using geriatric depression screen (GDS scale)

Compile and analyze initial data on Excel table-identify clients at risk of depression and collect information to engage in home visits

Observed, participated, and conducted five home visits with preceptor (two independently) 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/begin making appointments for home visits with high-risk clients & refer list to social services/continue research on depression and suicide in the older adult


Total: 32 clinical hours, 8 research hours 







Al-Amer, R., Ramjan, L., Glew, P., Darwish, M., & Salamonson, Y. (2015). Translation of          interviews from a source language to a target language: examining issues in cross-      


         cultural health care research. Journal of Clinical Nursing24(9/10), 1151–1162.  




Benbenishty, J., & Hannink, J. R. (2017). Patient Perspectives on the Influence of Practice of


         Nurses Forming Therapeutic Relationships. International Journal for Human Caring,    


         21(4), 208– 213. Retrieved from    




         ct=true       &db=ccm&AN=129524518&site=ehost-live


Goldstein, Zalman (2018). 14 Jewish Ways to Honor the Soul of a Deceased Loved One.


         Retrieved from https://www.chabad.org/library/article_cdo/aid/372952/jewish/14-  





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





Walden University (2017). What’s Your Conflict Management Style? Retrieved from





DRAFT: This module has unpublished changes.