Personal Learning and Social Determinants of Health Research Paper

Valparaiso University

College of Nursing and Health Professions

HS 180 Field Experience I

Reflective Paper Guidelines

At the end of your 36 hours, complete a critical analysis of your initial health care field experience. The reflection paper should be at least two pages in length and no more than five pages in length with one inch margins, 12 point font, and double spaced. A title page or abstract is not required and is not included in the total length. The paper should be written in APA format and include the honor code. Your paper should use headings and subheadings as appropriate. For example, please use headings/ subheadings of SMART GOALS, SOCIAL DETERMINANTS, and a heading of your choice to address question number three. Use your original personal objectives for your field experience. You must respond to the following questions in your paper.

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BELOW ARE THE QUESTIONS THAT NEED TO BE ADDRESSED IN THE PAPER. PLEASE USE MY NOTES TO EXPAND THE PAPER IN A MORE FORMAL MANNER.

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Question Number 1

Did you achieve your personal learning objectives for your field experience? If so, please describe in detail how this was accomplished and the specifics of what you learned. If not, why not, and how might you achieve these objectives in the future? Please list your two SMART objectives here and speak directly to these.

My Notes:

SMART goals.

1. Understand the daily responsibilities of what an APP does
   1. Accomplished – Prepare for clinics for patients considering surgery. Familiarize yourself with their condition and potential treatment plan. Discuss with the surgeon before meeting with the patient. During the visit, take notes and updates on the patient’s decision regarding surgery. Let the patient know what they need to do to be ready for their surgery. Preparing for post-op visits with patients and charting their updates and visits. Answering emails and phone calls from patients. Collaborating with the other APPs and doctors.
2. Learn how to interact with patients, colleagues, surgeons, and providers from other disciplines
   1. Accomplished – during clinic visits, we would collaborate with the surgeon. Before post-op visits, the cardiologist would come over to give the APP an update. There were nervous patients, talkative patients, anxious patients, and easy-going patients, and all of them were handled accordingly. If the APP needed any help from her colleagues they would always help, and she was also always willing to help her colleagues.
3. Learn how to take care of postoperative complications
   1. Accomplished – one patient’s stitch opened up near the groin after three months of surgery. The APP called him in and checked it out. She checked if it was infected and used a q-tip to see how deep the opened stitch went in. if it were too deep it would have been a problem. Fortunately, it wasn’t nor did it look infected. She cleaned it when betadine and bandaged it so it wasn’t exposed to the open. And sent the patient with a betadine bottle to use twice a day to help dry up the wound and also as an antiseptic, and antibiotics to avoid any infection. She told me the antibiotics were just a precaution but that she doesn’t think it would get infected. A patient who had undergone coronary arterty bypass came in with a seroma on his vein incision area. The APP removed the scab on the seroma over the incision site, drained the fluid until the seroma was soft, cleaned the area with a q-tip and betadine, and bandaged it. She showed me the fluid and told me that if it came out puss, it would have been infected. But that was not the case, the fluid was transparent with a hint of red (blood). Since the patient didn’t have constitutional symptoms like a fever, the APP wasn’t worried about an infection.
4. Learn how to perform wound care
   1. Accomplished – I learned a little bit about it. When we had post-operative visits, the APP would assess sternal instability in patients who had a sternotomy by pressing her fingers on either side of the incision and asking the patient to cough. She was feeling and hearing for any instability within the sternal wires which were keeping the sternal bones together. The APP can determine sternal instability by looking at chest x-ray and performing this physical exam. Some patients also had a stitch popping inward and she would remove it.

Question Number 2

Describe two social determinants of health that you learned more about during your shadowing experience. Give specific details of two encounters.

My Notes:

One social determinant of health that I encountered during my shadowing experience is the impact of smoking on surgical outcomes. In the case of an African American female who was a long-term smoker, the surgeon decided to postpone her surgery due to the increased risk associated with her smoking history. The surgeon explained that her lungs were compromised, which could lead to prolonged ventilation post-surgery. Additionally, the chance of her bypass/graft remaining open after surgery was low. By considering her smoking history of 40 years, the surgeon recognized smoking as a social determinant of health, influencing the success and safety of the surgical procedure. The decision to postpone surgery and recommend smoking cessation emphasized the importance of addressing individual health behaviors before proceeding with medical interventions. Another social determinant of health that I learned about was the impact of obesity on surgical risk and treatment decisions. During an encounter with a morbidly obese Caucasian woman requiring an aortic valve replacement, the doctor considered her high BMI (Body Mass Index) of 55 as a significant factor affecting the surgical outcome. The doctor decided not to perform immediate surgery because a BMI over 45 showed a higher risk for the procedure. Instead, he recommended that the patient return in six months after losing some weight and undergo a repeat echocardiogram. By taking into account the patient’s obesity, the doctor acknowledged the relevance of social determinants of health in shaping treatment plans. The decision to postpone the surgery and prioritize weight loss aimed to improve the patient’s overall health status and reduce the surgical risks associated with obesity. In both encounters, social determinants of health played a crucial role in shaping medical decisions. Smoking history and obesity were considered factors that could impact the success, safety, and long-term outcomes of the medical interventions. By addressing these social determinants, the surgeon demonstrated a holistic approach to patient care, recognizing that individual health behaviors and lifestyle choices can significantly influence the effectiveness of medical treatments.

Question Number 3

In addition, please respond to any two of the follow questions. You choose which two you wish to address (b & c):

b. What were your impressions of the environment in which you worked? Was it a healthy work environment? How did the environment impact the workers and the work that was done?

My Notes:

During my time at the cardiology unit at Northwestern Memorial, I was highly impressed by the positive and effective atmosphere that prevailed. The environment was welcoming, and I felt comfortable asking questions without fear of judgment. This aspect of the work environment fostered a sense of inclusivity and teamwork, contributing to its overall healthiness. One of the key indicators of a healthy work environment was the willingness of everyone to support and help one another. If a particular APP couldn’t accommodate a patient into their schedule, another APP readily stepped in to provide care. Similarly, if an APP needed assistance, whether from a surgeon, cardiologist, or another APP, they always received the necessary help. This collaborative spirit created a supportive network that positively impacted both the workers and the quality of the work being done. The positive work environment had several effects on the workers. It promoted a sense of camaraderie and team spirit, fostering strong relationships among colleagues. This, in turn, improved communication and collaboration, leading to a more efficient and effective workflow. The mutual support and lack of competition among colleagues contributed to a lower level of stress and burnout, which are common in highly competitive or hostile work environments. Moreover, a healthy work environment had a direct influence on the work that was done. The positive atmosphere encouraged open communication and the sharing of knowledge and best practices. As a result, the quality of patient care improved as collective expertise was utilized to address complex cases. The willingness to help one another also ensured that patients received timely and comprehensive care, further enhancing the overall patient experience.

c. What was your experience in working with your supervisor and your coworkers? How did you think that your supervisor and/or coworkers affected the work that you did? Based on the field experience, what qualities do you believe are necessary to be a good supervisor or coworker?

My Notes:

I really liked working with my supervisor and her co-workers because I was able to learn a lot about the heart with their help. I like my supervisor affected the work and knowledge I obtained in a positive way because she would always explain certain things to me that would help me understand the bigger picture. For example, for pre-op and post-op patients she would show me the work that they got done and explain to me what we were looking at in the scans. To show me the problem, she would first show me what a normal valve, for example, should function like. Then, she would show me the patients. This way I was clearly able to see and understand what was wrong with the patient’s heart. Based on my field experience, to be a good supervisor or coworker, certain qualities are essential. These qualities foster a positive work environment and contribute to effective teamwork. Here are some key qualities that I believe are necessary: communication, empathy, respect, collaboration, adaptability, integrity, supportive-ness, problem-solving skills, accountability, positive attitude, time management, and leadership.

Field Experience HS 180