Running Head: COMMUNITY CLINICAL AT LA FAMILIA

Community Clinical at La Familia

Bhagyashree Malatker
NURS 160 L
February 22, 2015
Laarni Herbert, RN, MSN

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Community Clinical at La Familia

La Familia began as a small clinic in 1972, which was dedicated to serve
the uninsured and underinsured. Since 1995, three more sites have been
added to facilitate the increasing demand to the surrounding neighborhoods,
two being similar sites with examination rooms and a fully equipped dental
center in collaboration with Santa Fe Community College. La Familia Medical
Centers are funded through many donors, some of which are; Health and
Human Services Department, the Santa Fe County Indigent Fund, the Santa
Fe County Maternal and Child Health Program, and the New Mexico
Department of Health. My assignment was to shadow a health clinic nurse,
and experience the different roles a nurse has in different health care
environments.
Roles of a Clinic Triage Nurse
At La Familia, I spent much of my day with a health clinic nurse who also
was responsible for triaging patients on her side of the facility. A clinic nurse
is responsible for various things including, rooming patients and prepare
them for the providers examinations, measuring vitals and obtaining health
history to determine the chief complaint. The majority of the work involves
administering vaccines, the anticipation and the collection of specimens
required for lab tests, and most importantly being the primary liaison
between the patients and the providers. The triaging part of it is similar but
has differences. Unlike a clinic nurse, a triage nurse is in charge of sorting

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out and evaluating patients based on how severe their inquiry is. Triage
nursing essentially assesses the patients which aids in the determination of if
the patient needs a higher level of care the facility cannot provide or if the
situation can be taken care of, without having the patient to go a more
expensive walk-in clinic.
Populations at La Familia
La Familia Medical Center caters to a wide range of demographics, in my
experience alone, I encountered people who belonged to each phase of the
lifespan; from infancy to school age children to pregnant women to geriatric
patients. There was also not a difference in the gender ratio among the
patients. Due to the location, Santa Fe, many people were of Latin American
backgrounds, who mainly preferred to speak in Spanish. Despite the variety
in the population, the common factor midst all of them was that they were
from low income communities.
Patient Education
A vital component of any area in nursing is patient education. Nurses are
an essential part of caregiving while in the facility but also after the patient
leaves. Successful patient education occurs through critically thinking about
what works for the patient and ensuring they are capable of being
independently managing their disease. At La Familia, patient teaching is
attempted at every patient encounter. There were two examples which
exhibit this. One being, after the administration of many vaccines, the nurse

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provided information sheets which stated what the vaccine is meant to

prevent and a list of side effects that may occur, based on patient
preferences, the handouts were in Spanish. The second was after an
encounter with a patient who came in to get a refill of a medication and did
not fully understand what they were for. Noticing that the patient was in a
rush to leave, the nurse explained to him what the medication does to the
body, and that he should not chew or crush the tablet while taking it. She
asked him to repeat the dosage and when he is allowed to take it. Confirming
the patients understand what they are being taught is also part of teaching
patients safe self-care.
Ethical Considerations
Part of nursing is the prevention of further suffering, at times,
interventions can be complex and cause patients to become more ill while
the attempt to restore their health goes on. Considering my nurse was also
responsible for triaging, she had to make the decision of evaluating the chief
complaint and prioritizing who is attended to first. One specific situation put
my nurse in a difficult spot. There were two patients that were admitted into
the clinic as walk-ins, one was 57 year old male complaining of chest pain,
and the other was a 16 year old female with a perforated ear drum. As per
her expertise in triaging, she consulted the male with chest pain before the
adolescent. Immediately rooming him, she asked me to take a set of vitals
while she reviewed his health history. All his vitals were within normal

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ranges, expect his diastolic pressure was a little high. He rated his pain a 2
out of 10, and appeared to be doing fine. He claimed to have the pain
constantly for the past two weeks. The patient asked if there is anything she
can do here, since he refused to go to the local hospital. He did not have any
EMRs with La Familia because it was his first visit. He insisted on getting
checked but instead the nurse advised him to go to the ED and said there is
not much she can do without a medical history. She explained that since
diagnosing chest pain can be a complex process, that if it was an emergency
it would be convenient to be admitted there. The patient leaves very
unhappy and told the nurse he was upset at her service and will not go to
the ED.
Situations like this can be very difficult for any nurse who is incapable of
helping. Although she was doing her job, the patients condition may
continue to get worse if he does not go to the emergency. The patient failed
to comprehend that the clinic did not have the means to give him the proper
care he needed. In a clinic setting, turning away patients is very common. In
this particular situation, turning him away left him with the impression that
the nurse was unethical and does not care, but rather she did the right thing
by taking a step back and advising him to consult higher level of care.
Conclusion
Being a clinic nurse at a facility which serves a large number of patients,
gives them the opportunity to consult a variety of people. Clinic nurses are

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also a key factor in sustaining the community and education the population
of how to prevent further illness and managing pre-existing conditions.
Although they are faced with many ethical challenges due to the basic level
of an unspecialized clinic, they manage to overcome obstacles by critically
thinking and proving the best care that is plausible with the resources at
hand.