NURS 4212 Week 11 Population Nursing Reflection Example

Reflection: Where Individual Thinking Crept Back Into My Population Work

Student Name

College of Nursing, Walden University

NURS 4212: Population Health Nursing

Instructor Name

Month Day, Year

Reflection: Where Individual Thinking Crept Back Into My Population Work

This reflection accompanies my final plan to increase blood lead testing among young children in four Portsmouth census tracts. Rather than summarize the course, I want to examine my own drafts. Three times this term, the habit of thinking about one patient at a time crept back into work that was supposed to be about a population. Each time something corrected it, and the corrections are what I most want to keep.

Three Moments

The first came in my Week 3 demographics section. My first draft of the age paragraph read: "The county's older population will need more chronic disease management, medication teaching and home health visits." Every item on that list is something a nurse does for an individual. I had read a population characteristic as a caseload. My instructor's comment asked what the age structure meant for the county, not for its clinics, and the revised paragraph linked age to chronic disease burden and transportation need as things to test in later data. Looking back, I see that the original sentence was not wrong so much as it was aimed at the wrong unit of care.

The second came in my Week 5 post on diabetes in Portsmouth's low-access tracts. An early draft said: "Residents of these tracts need education on healthy food choices." The week's reading had placed individual lifestyle inside wider layers of social and living conditions (Dahlgren & Whitehead, 2021), but I had written the sentence before taking that model seriously. What changed it was data that did not fit: two of the six low-access tracts had diabetes estimates below the city average, which told me the pattern depended on more than food choices, and the tracts with the highest estimates were also the poorest and had the fewest cars. The final post argued from the living-conditions layer, and it reported the two tracts that did not fit rather than dropping them.

The third came in my Week 10 plan. My first draft of Objective 2 read: "80% of parents of children with elevated lead levels will demonstrate understanding of lead safety practices." It was measurable and time-bound, and it was aimed entirely at individual parents. A Cochrane review I found while writing the activities section showed that household education and dust control alone had not lowered children's blood lead levels as a population measure (Nussbaumer-Streit et al., 2020). If education alone does not change the outcome, an objective built on education was measuring the wrong thing. The final plan kept home visits but added an objective for referring hazards to housing code enforcement, which acts on the homes rather than on the parents.

What These Moments Share

In each case the first draft was written quickly and from habit, and the correction came later, from outside the habit. Schön (1983) separated two moments of reflection: reflection-in-action, which happens in the middle of practice while its course can still be altered, and reflection-on-action, which looks back once the work is done. This paper is reflection-on-action. I can see the three moments now because the drafts are finished and saved. None of them was caught while I was writing; each was caught by someone or something else afterward.

That is useful, but it is slow. A population habit that only shows up in revision will not help me at a bedside, where there is no instructor comment and no second draft. The question I want to carry forward is how to move one of these corrections from reflection-on-action into reflection-in-action.

A Habit to Practice in Action

The habit I choose is one question, asked during admission of every patient whose problem has a population pattern: "Who else is in this situation?" When I admit a woman from Portsmouth's east end with heart failure and a 30-day readmission, I will ask whether her home has air conditioning and whether she lives alone, not only because it matters for her discharge but because the Week 6 analysis counted roughly 900 people like her, older and alone, in the city's six most vulnerable tracts. When I learn something that applies to many patients, such as a pattern of readmissions from one neighborhood, I will write it down and pass it to our case management team or to the health department rather than keeping it as a story.

I chose this habit because it is small enough to practice in the moment and because it connects the two kinds of care this course has shown me. The bedside is where I meet the population one person at a time. Asking who else is in the same situation is the smallest step from treating a patient to noticing a population, and it is the step I most often skipped before this course.

References

Dahlgren, G., & Whitehead, M. (2021). The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health, 199, 20-24. https://doi.org/10.1016/j.puhe.2021.08.009

Nussbaumer-Streit, B., Mayr, V., Dobrescu, A. I., Wagner, G., Chapman, A., Pfadenhauer, L. M., Lohner, S., Lhachimi, S. K., Busert, L. K., & Gartlehner, G. (2020). Household interventions for secondary prevention of domestic lead exposure in children. Cochrane Database of Systematic Reviews, (10), Article CD006047. https://doi.org/10.1002/14651858.CD006047.pub6

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books.