The document discusses the author's internship at Grand Strand Medical Center and how it exposed them to the influence of social determinants on patient health. The author observed how factors like housing, employment, access to healthcare, substance use, and insurance coverage affected patient outcomes and recovery. Effective communication between healthcare professionals was important for coordinating patient care, though miscommunication sometimes occurred regarding patient diets. The author believes health education and promoting positive behaviors can significantly impact individuals' health.

1. Elizabeth Cox
Dr. Ron Gimbel
HLTH 4200
July 2016
Public Health Determinants and Trends
Social Determinants in Health
Grand Strand Medical Center is part of a multi-facility health system that serves the
Myrtle Beach and Grand Strand community. As a designated Level II Trauma Center and
Advanced Primary Stroke Center located in a favored vacation spot, Grand Strand Medical
Center serves a wide range of patients of various and diverse backgrounds. Working in an
acute care setting provides a landscape of medical conditions and injuries ranging from
minor to life threatening. As a speech pathologist you are heavily exposed to the myriad of
patients as you work alongside physicians, surgeons, nurses, and other therapists to
facilitate the recovery process. However, speech therapists are most frequently involved
with patients who suffer from brain or spinal cord injury, stroke, heart conditions, trauma,
or any injury or condition that alters or hinders overall cognitive function. Most of these
patients will continue to a rehabilitation facility where they will work closely and
intensively with a range of therapist to regain lost function. Throughout my undergraduate
studies at Clemson I have learned the influence social determinants play on an individual’s
health status. Social determinants can include but are not limited to the individual’s
housing and safety of the place in which they live, employment type, access to health care,
availability of healthy foods or access to options for physical activity. All of these factors
have an impact on an individual’s health and their future. I was able to apply these concepts
I have learned throughout my studies to my experience at Grand Strand Medical Center and
was able to experience first hand how these determinants affect an individual’s health and
prognosis. During my internship the daily conditions in which people live, the prevalence of
alcohol and drug use, and the availability of medical and insurance coverage were factors
that heavily impacted the patient’s health status and projection of recovery.
The daily conditions in which people live and work both play a large role in health
outcomes. Many patients were admitted to the hospital and needed to seek long-term care

2. as their daily conditions at home were not sufficient for their current health status. The
individuals who lived in lower income housing with unsanitary conditions and a lack of
healthy habits were most likely to end up in the hospital. These individuals often stayed at
the hospital for a longer time period due to the lack of a stable environment to return. Daily
conditions affect an individual’s ability to achieve proper hygiene, nutrition, physical
activity and positive overall health status. As people age it is common to lose the ability to
meet these needs independently therefore their quality of care and health outcomes
depend on another individual. I found it important for many of the patients I saw during my
internship to have a caregiver present yet most failed to do so. Patients suffering from
dementia often ended up in the hospital due to forgetting to take medicines or overdosing
without knowing. It is more difficult for the elderly who live independently to seek medical
attention when needed and in the appropriate amount of time. Age eventually alters an
individual’s daily living conditions and I found it important for these people to adjust and
seek help to better not hinder future health outcomes.
After spending only three months at Grand Strand Medical Center, I was constantly
reminded of the negative effects drug and alcohol have on an individual’s health. As a
tourist town, the prevalence of alcohol outlets in this community is remarkably high,
encouraging a heavy drinking culture. From the patients I saw during my internship, I
presume the availability and cost of illicit drugs in this community is comparable.
Frequently engaging in these behaviors puts individuals at risk for a number of serious
health problems. Not only did I see patients severely injured from motor vehicle accidents
in which drugs and/or alcohol played a role, but patients suffering from chronic diseases
that were directly related to previous alcohol consumption and drug use. Heavy drinking
puts individuals at risk for increased blood pressure, kidney and liver disease, heart
attacks, and strokes, all conditions I saw first handedly at my site. Many individuals
suffered from extreme withdrawals during their stay at the hospital making the experience
more painful and difficult than necessary. More specifically to the speech pathology field,
the use of alcohol impacts the efficiency of an individual’s swallow. Heavy drinking leads to
tearing in the walls of the esophagus making swallowing painful and difficult. These
esophageal problems eventually limit an individual’s ability to eat and drink certain things.

3. Not only is the prevalence of alcohol and drugs detrimental to health it often leads to a
longer and more unpleasant hospital stay.
Availability of insurance and medical coverage heavily impacts a patient’s recovery
plan. Many patients who suffer from a severe injury or incident need long-term rehab,
which can be very expensive. Rehab centers consider insurance when accepting patients to
their programs often turning down those with minimal to no insurance coverage. Without
insurance it can be very expensive to pay out of pocket for long-term rehabilitation
services, which limits the individual’s ability to fully recover. In most circumstances
rehabilitation services are intensive and aggressive and need to be started as soon as the
patient is able. Patients without insurance often spend valuable time waiting to be accepted
to rehab and therefore lose much needed therapy time.
Due to the large influence social determinants have on a patient’s health status, it is
important as healthcare professionals to take these factors into account to ensure positive
health outcomes.
Organizational Behavior and Governance
Interning in the acute care setting illustrated the critical interaction of all
professionals under each and every circumstance to ensure the best possible health and
treatment for each patient. Majority of patients who are admitted to Grand Strand hospital
see several different nurses, therapists (PT, OT and Speech), surgeons, doctors of a variety
of specialties, hospitalists, dieticians, nursing assistants, and social workers throughout the
duration of their stay. Each individual who interacts with the patient notices changes, offers
suggestions, and has an opinion about the best possible treatment plan for the patient. It is
extremely important for these individuals to communicate and work together as a team to
diagnose, treat, and make plans for each patient. Before entering a patient’s room, my
preceptor and I would spend time speaking with the patient’s RN and CNA to discuss their
current status as well as important medical history, diagnosis, test results, medications,
symptoms, and how effectively they have been eating and drinking. We also spent time
conversing with the doctor or PA who is following the particular patient to discuss their
status in further detail. This provided a solid background of information prior to entering
the patient’s room allowing the SLP to have a better understanding of what to expect, what

4. to look for, and what to treat. Following an evaluation or therapy session, we would
reconvene with the RN, CAN, doctor, and PA to discuss the session and suggest further
treatment and action.
Technology plays an important role in the efficiency of communication in the
hospital. Each professional carries a pager and a cell phone at all times throughout the day.
This makes it easy to communicate when they are with another patient or busy doing
something else. Often the SLP cannot suggest a swallow or speech disorder treatment plan
without approval from the doctor and often these conversations and decisions are
discussed and approved over the phone as most doctors are constantly traveling
throughout the hospital. Every time a patient is seen or a status change is noted, regardless
of the type of professional the individual is required to enter notes into the computer
system. Prior to speaking to nurses and doctor’s about a particular patient, my preceptor
and I would spend time reading the notes under the patient’s file that were completed by a
variety of surgeons, nurses, doctors, and therapists who have seen that patient. This is
another form of communication that plays such an important role in this setting. The clarity
and depth of these notes is important for any professional who will be a part of the
patient’s treatment plan.
However, communication is not always effective nor is it perfect when there are
several individuals working on one particular case. Throughout my time at the hospital I
noticed one problem that arose several times due to a lack of communication. After a
patient’s swallow function is evaluated, the SLP recommends a particular type of diet to
follow both for solids and liquids. This diet is often restricted to ensure safety when the
patient swallows. After determining the appropriate diet, the SLP notifies the nurse and
often the doctor to put in an order through the computer system to the cafeteria. This
ensures that the patient will receives meal trays that are appropriate for their diet level and
that the patient will only eat or drink items that pertain to their recommended diet.
However, there is often a lack of communication when the daily shift occurs and nurses go
home for the evening and someone new is in charge of their patient. I noticed several
occasions where we would visit a patient on a restricted diet and find something in the
room they were not allowed to be eating or drinking. Most often, the reason for this
occurrence was the nurse failed to read the patient note or speak to an SLP about the

5. patient’s recommendations and either brought them exactly what they asked for (ex. thin
water) or allowed family members to bring in food or drink items from home. It is
extremely important for patient’s to follow their recommended solid and liquid diets when
experiencing swallow dysfunction to prevent further problems. The hospital has started a
new system that requires SLP’s to hang a diet recommendation sheet in the patient’s room.
The sheet is bright yellow and is normally hung above the nurse’s computer in each room. I
have noticed that when the paper is visible in the room, it is less likely for they’re to be
miscommunication about the patient’s recommendations. This has prevented issues of
patient’s eating and drinking things that are unsafe for them at their current status.
Communication plays an important role throughout the hospital in all departments.
PT’s, OT’s, and SLP’s all communicate constantly throughout the day about patient’s
advancements, changes, difficulties, etc. SLP’s also discuss treatment plans for patients and
exchange ideas about what each thinks are best fit for that patient. Communication is key
among each department, each unit, each floor, each specialty, and most important each
team that is working together to achieve the best possible health status for a patient. It
takes a team to create a treatment plan and a team that communicates efficiently to carry
out a successful treatment plan. I think a simple meeting regarding the importance for all
professionals in the hospital would remind them that no detail is unnecessary or unheard
and the value of working as a team is irreplaceable. Overall, I think Grand Strand does a
phenomenal job communicating with one another and has found success in using
technology and other strategies to continue to better their communication. For the most
part, each professional actively listens to one another and never hesitates to provide
information and detail when they feel necessary. However, I don’t’ think it ever hurts to
congratulate the faculty on their efforts thus far and encourage them to continue to
effectively communicate through the hospital each and every day. Simply not mentioning a
certain condition, not documenting a specific medicine, or not listening to important words
from a physician can cost a patient’s life. Communication is of utmost importance in the
health field and I think Grand Strand Regional Medical Center’s emphasis on active and
effective communication is what makes them a successful and prestigious hospital.

6. Health Promotion and Education Concentration
As an individual with a concentration in Health Promotion and Education, I believe
behavior has the most significant impact on an individual’s health. Day to day we make
choices, some are small and seem insignificant while some are much larger decisions that
can be life-changing. However, each choice we make whether it’s to act or not to act, to
move or not to move, to walk or to drive, to drink more or to go home, to check your phone
while driving or to wait, each choice affects our health. Choosing healthy and safe behaviors
promotes a healthy lifestyle and essentially healthy outcomes.
During my internship, an annual motorcycle rally occurred in Myrtle Beach during
the last weekend of May. The number of fatalities and injuries due to motorcycle accidents
as well as alcohol and drug activity during this week is alarming year after year. Individuals
choose to speed and weave in and out of traffic, drive or ride on a motorcycle without a
helmet, or engage in drinking or drug use before hopping on a motorcycle. These are
decisions that affect these individual’s health as many end up with life threatening and life
altering injuries. These individual’s also put others at risk when they choose unsafe
behaviors increasing the likelihood of severe accidents. Motor vehicle accidents as well as
motorcycle collision patients often suffered the most extreme and life threatening
conditions. Many harmed another individual or loved one in the process of the accident
adding guilt and emotional distress to their recovery process. Due to poor decisions these
individual’s changed their future, their quality of life, and limited their abilities for years to
come.
Another common occurrence throughout my internship was the number of patients
who were overweight, living a sedentary lifestyle, and eating unhealthy regardless of their
health status. Due to sedentary lifestyles and a lack of nutritional diets, many patients
suffered from hypertension, diabetes, stroke, CVD, and many chronic diseases. These
patients were often the ones with the most severe disease or condition facing a long road to
recovery. Under most circumstances, it is not the healthy and active people that you find in
the hospital, it is those that live and unhealthy lifestyle and make poor behavioral
decisions. The patients that suffered the most were often those with the longest most in
depth medical history and majority of the conditions they faced were due to behavioral

7. choices such as smoking, drinking, lack of physical activity, lack of an adequate diet, or
accidental injuries.
Unhealthy decisions increase the need for acute care as a whole. From surgery to
therapy to rehab these patients suffering from poor behavioral choices need a variety of
services throughout the hospital. Grand Strand Health as a whole strives to promote
healthy behaviors and lifestyles to patients, caregivers, family members, and loved ones.
However, in a hospital setting often the individual has already suffered the consequences
from unhealthy behaviors or poor judgment. At this juncture, efforts need to focus on
preventing the patient from worsening their conditions by choosing unhealthy behaviors
following discharge from the acute care setting. Patient education is offered through
booklets on a variety of topics throughout the hospital. For example, stroke and brain
injury patients receive in depth booklets about their condition, their recovery, and their
future. However, I don’t think patients spend enough time reading these books or focusing
on what has gotten them to this place. I think increasing the overall promotion of health
throughout the hospital would greatly benefit the status of patients and the health of the
community. Preventing patients from reaching the hospital in the first place would be the
most ideal. However, training staff to spend time with the patients and discuss past
behaviors and how to change these behaviors to better their quality of life would be
beneficial to the individuals and family members. Readmission can be prevented by
counseling patients during their stay to choose healthier options when discharged. I have
found that it is easy to forget the importance of educating patients on healthy behavior
choices and promoting these behavioral changes in the acute care setting, as many are
quick to assume change is not beneficial at this point. However, professionals are given the
opportunity to not only improve the patient’s status during their hospital stay but also
their future as well. Preventing and reversing unhealthy behaviors is not over because the
patient is in the hospital, this simply opens a new set of doors to prevent future problems.
This internship widened my eyes to the importance of maintaining a healthy
lifestyle as well as striving to make healthy decisions each day. It has also inspired me to
incorporate health education and promotion in my future career and to encourage my
patients to achieve a healthy lifestyle regardless of their current circumstances.