Researcher of the Month
November 2009
Diana N. Gonzalez
Nursing & Women's Studies majors, EOP/AIM program, Class of 2010
Mentor: Prof. Françoise Cromer, Women's Studies
If you want to meet someone passionate about her work, brimming with enthusiasm, initiative
and drive—talk to the November 09 Researcher of the Month, Diana Gonzalez. Does she ever deliver!
Diana is a dual women's studies and nursing major, class of '10, whose independent
research project under the mentorship of Prof. Françoise Cromer of Women's Studies involved
data collected in June 2008 while doing a clinical internship at the Enrique C. Sotomayor
Obstetrics and Gynecology Hospital in Guayaquil, Ecuador. For her study, Diana interviewed
41 patients 
and looked at how each patient classified the treatment she received during her stay,
the demographics of the patient population and examined the effects of race and class
on the treatment of patients. Preliminary analysis suggests a need for improvements
in health care delivery methods —e.g. better patient-provider communication; and a
patient-centered health care policy approach specific to the needs of low socio-economic
patients.
Diana originated the research project idea herself, contacting the hospital director
on her own initiative to get permission to do the study and to make all necessary
arrangements for her 4-week internship. Diana also worked with obstetric/surgical
personnel there, including Dr. Peter Chedraui, Chief of the High Risk Pregnancy Labor
and Delivery Unit, as well as her SB mentor, Prof. Cromer, on honing the interview
tools/survey instruments she would use to collect data. Diana's obstetric medicine
internship and research project culminated not only in a 40+ paper which she later
submitted for her women's studies major requirements; but in addition, Diana had primary
responsibility to perform vaginal delivery to a patient and bring a healthy baby boy into the world on the last day of her internship!
Shortly after presenting a poster at URECA's Celebration last April, Diana's abstract
on "Patient Population in the Labor Unit" was published in Imprint, a publication of the National Student Nurses' Association; currently she is working
on condensing her findings for future submission to a nursing research journal. Diana
also presented her research at a lunchtime seminar last summer at Lenox Hill Hospital where
she completed a clinical internship on orthopedics and neonatal intensive care. Diana
will also soon have the opportunity to present her project to a new audience, in another
part of the world entirely, while participating in "Discovering China", a special
SUNY study abroad program where she will take part in a ceremonial showcase of student
research (January 2010) .
Diana aspires to become a certified nurse midwife and pediatric nurse practitioner,
and eventually to pursue a doctorate in nursing practice. A pivotal experience for
Diana Gonzalez at SB was taking— and later serving as a Teacher's Assistant for —Dr.
Paul Ogburn's class in Maternal and Fetal Medicine / Women's Studies 401 (spring 2007).
Born in Queens NY, Diana has had numerous opportunities to visit Ecuador (home to
much of her extended family) and is a fluent Spanish speaker. During her volunteer
experiences at Stony Brook Hospital, she has drawn on her bilingual skills to help
facilitate many patients' quality of healthcare, making sure that patients understand
what is happening during their hospital stay. Diana Gonzelez is a participant in the EOP-AIMprogram,
and serves as an SB Student Ambassador. Diana is very positive about the experiences
and opportunities she's had overall at SB, and is immensely appreciative of EOP counselors:
"EOP has been a huge influence in how I am because of all the support and encouragement
they give. I would not have accomplished so much if it wasn’t for them!" Below are some excerpts of her interview with URECA Director, Karen Kernan.
Karen: How did you first become involved in research?
Diana: I wanted to gain clinical experience before entering nursing school. So I had the
idea to go to Ecuador. My family is from Ecuador. I researched the local hospitals
in the area. And I contacted the director there. I told him that I wanted to be a
nursing student in the future, and that my passion was the field of maternal fetal
medicine. I had taken a class on this side of campus, a women’s studies class, called
maternal and fetal medicine. And I had TA’d the class. The director at the hospital
accepted me; when I went to Ecuador, he put me in a group with obstetric / midwifery
students. They knew so much …everything I learned I really learned from them.
Together with the group of students, did you get the opportunity to observe a lot
of patient care and hospital procedures?
I began by observing. The first 2 weeks I was mostly observing. I saw a lot of things—
C-sections, tubal ligations, ectopic pregnancy surgeries. I went with the other students
to their lectures too. I went once or twice on a night shift too to observe. It was
great. By the second two weeks, I had proved that I learned a lot and they trusted
me with more responsibility. I was able to listen to fetal heart rates with the bell
[the picture you see above]… they taught me how to find the heart rate, how to count it … The very last day,
I was able to deliver a baby! They were with me but I did it all on my own. I have
a video of the birth which I showed at the URECA Celebration.
Wow! Tell me more. What did you learn?
I used what I learned in the 4 weeks at the Obstretrics & Gynecology Hospital in Guayaquil,
Ecuador as a basis for an independent project. I got credit for this to finish the
major requirements for Women’s Studies, working with Prof. Cromer. My mentor helped
me figure out and develop a research project before I traveled there based on what
my interests were. In particular, I was interested in examining whether race would
be a variable in health care delivery to patients at this hospital. It was a low income
hospital, with a mix of races. My research was aimed at identifying the demographics
of the patient population : of the patients I surveyed for my study, it turned out
that 78% were Mestizo or an ethnic mixture of European Spanish with native indigenous,
12% were of African origin (Afro-Ecuadorian), 7% of mixed Mestizo and African descent
and 3% native indigenous.
What I found out, though, was that race was not a significant variable in health care delivery. It was really class that turned out
to be a determining factor in the quality of patient care. The hospital was divided
into 3 levels. There was a “pensioned” level for those that could pay for better treatment,
a semi-pensioned level, and a general subsidized level where patients were paying
$80 for a delivery, and ~$150 for a Caesarean. During my stay, I was in the general
subsidized level patient area. When I interviewed midwives and doctors, who worked
on other levels too, one midwife said to me directly: “There is a difference in treatment.
When I work upstairs, you must treat the patient better because they pay for it.”
From my observations, although the medical treatment regimens and procedures were
the same, and the medical care was consistently excellent…what wasn’t the same was
the patient treatment, the way the medical staff interacted with patients.
Was it difficult for you to collect data for this type of research project?
Prof. Cromer helped me so much. She’s a wonderful mentor. Before I went, we would
meet every week and talk about my project, what I was going to be looking for, etc..
I had a plan in place to interview midwives, doctors there. I made an interview protocol
for them. Once I was in Ecuador, I connected also with one of the doctors at the high
risk delivery areas, Dr. Peter Chedraui . He helped me work on developing the interview
protocol for the patients. I would also email Prof. Cromer from Ecuador and get her
advice about the interviews and what to do. I stored everything I needed for my project
in a book. When I would go to the recovery room to interview a patient, I had my book
with me. Starting with patient 1, I would ask all the questions that I had in my protocol.
Then next, patient 2… in the two weeks I spent conducting interviews/surveys, I spoke
with 41 patients!
What was the most surprising result you found?
I was there when the patients were delivering and I saw for myself what the treatment
was. I anticipated that the patients would tell me honestly how they felt. I thought
what they said would coincide with what I was seeing. But instead, a lot of patients
responded : ”everything was ok, there wasn’t anything that could be improved.” Only
a few patients told me, for example: “when I had to go to the bathroom or change beds,
I had to do it on my own. Nobody helped me…. I wish I could have had somebody with
me during the labor. …I really wish the hospital gave more feminine pads. …” And that
was a surprise to me. My real purpose for this project, besides the academics and
getting the credit for my major …. was really to make a change for them. I thought
the patients would take advantage of having the chance to speak. But I came to realize
that patients there aren’t really used to being asked the types of questions I was
asking. Many had primary education only. Most were not used to being asked for their
suggestions or opinions. They didn’t want to get into trouble or appear to be complaining.
Do you think that the implications of your research –for ex., that there is a need
for more patient-centered communication--will reach those who can make changes?
That’s what my hopes are. The hospital is rebuilding and plans are already in place
to make it bigger, and better. They deliver close to 30,000 babies a year now. They
are trying to make improvements. I’m hoping that they’ll consider this project, and
improve not only the medical aspect but also the treatment of their patients. ...What
I hope to see as an outcome from my project would be for the hospital to make improvements
in patient care...and realizing the need and value of practicing a patient-centered
care model—empowering the patient, giving them the right to have a say in their health
care, making the patient a decision maker in their care. From the experiences I had
there, and what I saw, the patients weren’t really asked, they were told. They weren’t
given explanations about what was happening to them. The most dramatic example of
this that I witnessed involved a patient who had an ectopic pregnancy and needed surgery.
She had not been educated on the potential implications of her surgery...
What perspective did you gain from this experience?
Having worked in a third world health care setting. . I could see that the implications
of class not only on healthcare but on having your voice be heard. I’ve seen so much
already. And realizing that I can actually make a difference for a patient—particular
experiences I had that summer —motivates me and shapes what I can do now as a nursing
student. When I'm at Stony Brook hospital, and I see immigrant patients here… I try
to really make a difference in the care they receive. I make sure they understand
what’s going on. I make it my priority to explain and to empower them through education
and making sure that all their questions are answered.
Just last week I had a teaching project to do as part of my clinical. My assignment was to teach breast-feeding. But my patient was Spanish-speaking only. I had prepared a brochure . . . but she wasn’t going to be able to read it. So I went back and translated the entire brochure and lead the teaching session in Spanish so that the patient could have the information. Some patients, like her, can barely read and write. They have to fill out all legal forms to get the birth certificate, forms for Medicaid, things like that… from that, plus various other experiences I’ve had, I realize I really love working with underprivileged patients, working with immigrants… each time I am able to even do something so simple as translating I know that I have a made a difference. I realized that I’m drawn to those patients who need the most help. Sometimes, I was the only Spanish speaking volunteer around.
Were you always drawn to nursing?
I always was so fascinated by pregnancy and fetal development--in high school, even
elementary school. When I came to college, what drew me as a career path most was
nursing because I wanted to be a nurse midwife. I wanted to do a double major, I chose women’s studies so I’d could better understand
my patients if I was to become a nurse midwife. Now at my second year in nursing school,
I know that I could not have chosen a more wonderful and rewarding career.
You mentioned a women’s studies class that had a significant impact on you. Did it
involve out of the classroom experiences too?
The course was Womens Studies 401, Maternal & Fetal medicine with Dr. Ogburn. He’s
an OB/GYN at Stony Brook Hospital. He oversees the course, which is taught by undergraduate
TAs to a group of ~12 students. Part of the class is going to labor & delivery at
the hospital. You get to see a birth and a C-section. You can see as many as you want.
When I was in the class, I saw 7 or 8. I was there all the time.
What are your long term goals?
Eventually I will go for a doctorate in nursing practice (DNP). In the more immediate
future, after a few years of nursing experience, I would like to become a pediatric
nurse practitioner and then also a certified nurse midwife. I did an internship at
Lenox Hill hospital this past summer where I worked in the neonatal intensive care
unit … and I loved it! I absolutely loved it! Now, in my nursing clinicials this semester,
I've rotated through pediatrics and I've found my new passion:I want to be a pediatrics
nurse for my first job. It is a true blessing to work with children!
It's great that you've had the opportunity to experience a variety of internships
and experiences.
Working at Lenox Hill was certainly much different from my experience in Ecuador.
Although, I didn’t encounter many patients of low income at Lenox Hill, it was a great
learning experience … I feel much more confident now when I am working with patients
during clinicals. I had a wonderful time! Patient treatment was a priority. The nurses
that precepted me were “super nurses” as I like to call them. They taught me the patient-centered
approach--how to go beyond looking at the patient's list of medical problems, how
to educate and give emotional support to the patient and to the patient’s family.
So what’s next for you, with regards to your research?
Several of my nursing professors are midwives and specialists in women's health. I’ve
shared my research experience with them and they are encouraging me to publish the
work. It can’t be the 40 page paper I handed in to Prof. Cromer for my women’s studies
project but a shorter version. They have offered to help me through the process of
condensing what I did for my independent research project into a nursing journal article.
My goal is to publish the study and then send the article to the director of the hospital
in Ecuador
Last April you presented at the URECA Celebration. Was that the first time you formally
presented your research?
I presented it again this past summer, when I showed my poster at a lunchtime session
at Lenox Hill Hospital. But yes, the URECA Celebration — that was the first time I
presented and I loved it! I had gone to URECA’s Celebrations before. I always said
I want to present here one day. . Since my first year in college I wanted to do a
research project and am so happy I did! Everyone who stopped by was so interested
in the topic and excited to see the pictures, the videos. My purpose for the research
was to expose the realities of third world healthcare. And I think people were able
to capture that message. They saw how excited I was, that my goal was to give a voice
to the patients. Nobody there had ever really looked at this area—only at the patients,
what their wants and needs are. This project allowed me to focus on just that. Dean
Stein, Sister Margaret, a lot of faculty, my academic advisors from EOP, they all
came by. A lot of my friends came by as well. It was wonderful to be able to share
this experience with them. It's so valuable for people to see how different health
care is in third world countries and how fortunate we really are.
What was the hardest thing about doing your project?
Writing the paper— getting all of this together. Getting all that information on a
spread sheet and making sure I had no errors , going through the interviews with the
doctors and midwives… going through existing literature …and then, really just compiling
it into a paper. When I was in Ecuador, I remember saying to myself: how am I going
to do this? I had so much information and had to find the best way of organizing it.
Thankfully, with the help of Prof. Cromer, my paper turned out great.
What advice would you give to other students?
Quite honestly (and I’ve told many of the younger EOP students and my classmates too!),
it’s really not as hard as it seems. Things can be done. That’s really my advice:
things can be done, there is a way. Many students get overwhelmed with the idea of
research. They feel it seems impossible to reach professors, find a topic, etc...
But it really takes wanting to do it and most importantly having a purpose for it.
In my case, I knew what my purpose was. And it all came together. I knew that completing
this project would be rewarding and worthwhile. You can’t allow yourself to be discouraged
by the idea that this is too much for you to do. You have all the tools you need right
at your fingertips. I had my professors’ support at Stony Brook. Everything you need
is here. You just have to be attentive, look for things…don’t stay behind, don’t’
feel overwhelmed. It’s really up to you!