INTERNSHIP

Reflection:

I had the opportunity to complete my internship with Wake Forest Baptist Medical Center in Winston Salem. Specifically, I was working at the BestHealth for Us department which focuses on employee health throughout the hospital system. I was able to work under a preceptor named Gretchen Bayne, who has been the Wellness Manager for over ten years.

Before this internship, I have had a small interest in work site wellness and employee health, but I had never taken any initiative in learning more, whether that be taking a class or researching jobs. The only experience I had was through my graduate assistant experience, helping to create a "review of reviews" on work site wellness research papers. I thought that this would be a good opportunity to try something new but still incorporating my interests of physical activity and nutrition.

I was assigned a multitude of tasks throughout my time at BestHealth for Us. My biggest solo task was working on stress management in the workplace. I had been tasked with creating videos for de-stressing at work. They vary in length from 3 minutes to 15 minutes and people can choose which one best suits them. Some are stretching, some are meditative, and some focus on writing. I have also started writing emails to send to participants in the Watch Your Weight at Work Program. These emails are sent twice a month and share tidbits on tips and tricks for eating healthy, de-stressing, sleeping better, exercise, etc. I also worked at many Employee Wellness Days where I gave information about our programs we offer and making sure people know what the health risk assessment is and how they can do it. I was able to lead the donations section of our yearly Employee Wellness Day for the staff of Wake Forest Baptist Medical Center. I contacted local stores and restaurants as well as National chains to acquire raffled gifts and door prizes to attendees. These donations range from gift cards, luxury items, to monetary donations. The best item I secured was a check for $1,300 from Whole Foods which is the biggest donation BestHealth for Us has ever received in the history of hosting Employee Wellness Day.

I have also realized how intimidating evaluation can be. I sat in for a REDCap meeting which is a software that will help show if any significant change happens in the programs BestHealth for Us implements, and it is difficult. I also feel like I gravitate more towards the assessment and implementation, and less towards the evaluation. To do a program evaluation, there is much more than a simple critique. You must use both quantitative and qualitative data to ensure all things are looked over. Stakeholders who work on the program and receive the program all have different roles and it is up to you to identify them. Creating logic models help ideas flow and create timelines of programs. Essentially a program evaluation seeks to see if a program is efficiently running or not, and if not, how can it be improved? This is done by assessing and documenting the program implementation, the outcomes, and the efficiency and cost-effectiveness of the activities.

My biggest revelation I discovered while completing my internship has been my interest in becoming a dietitian. I have come to this realization because I work with three amazing dietitians in my internship: Sarah, Jane, and Katie. Some of the duties they do is having one-on -one counseling with employees where they help with eating more intuitively and making sure they know they aren’t falling into unhealthy fad diets. I have always enjoyed doing this with my friends and seeing those three do it for others makes me really want to be able to do it too.

I have our monthly newsletter in hand at an Employee Wellness Day. We offer snacks and information about different health programs employees can join. I also answer questions about the health risk assessment.

Creating peanut butter energy bites for an Employee Wellness Day. This is a healthy snack alternative that is easy to make and eat.

Serving peanut butter energy bites and giving prizes for participants in the 'Maintain Don't Gain' Holiday challenge. Teams that managed to keep weight off during the Christmas and Thanksgiving holidays choose a prize

Methods:
I have created a Program Plan entitled, The #CODE HEALTH vending machine. The #CODE HEALTH vending machine helps employees make healthier decisions by using a different face, point-of-decision stickers. Happy face stickers indicate the healthiest choices (“Go!”), straight face stickers indicate in-between choices (“whoa”), and frowny face stickers indicate the least healthy choices (“oh no”). The program will include other materials, like posters, table tents, e-mails, bimonthly newsletters, and signs to help Wake Forest employees make healthier decisions, explain the meaning of the stickers, be conscious of the decisions they are making, and promote items in workplace snack shops and cafeterias.

The Socio-ecological model and the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, are the Theoretical models that support #Code Health. The ANGELO framework details that a person's nutrition behaviors are influenced not only by individual factors like taste preferences, self-efficacy, and motivations, but also by other environmental factors such as the social environment (eg, social norms, role modeling), the physical environment (eg, settings and the foods that are available in them), and the macro-environment (eg, food systems, advertising, prices).
The food options for the vending machines will be chosen by the three registered dietitians on staff. The program will try to identify and increase the number of healthy offerings at each vending machine and will aim to recruit local vendors in the area if possible. Smiley face foods will be sold at a discounted price, straight faced foods will be sold at regular price, and the frowning face will be sold at 1.5x the regular price. Posters explaining the sticker concept will be placed around the hospital and near every vending machine, encouraging its use. Emails will be sent out to the employees through BestHealth for Us promoting the vending machines as well as including wellness tips and trips.

Observations:
At the main campus of Wake Forest Baptist Medical Center there is a central cafeteria called Fresh Inspirations cafe. At the Fresh Inspirations Cafe in Ardmore Tower, you can choose from a wide selection of food options including: Hearty, hot meals at the entrée station, classic favorites at the grill, healthy and light options at the salad bar, pre-made salads and sandwiches in the Simply To-Go Coolers,a mindful station with different options throughout the week, including a Tex Mex bar on Tuesdays and Thursdays, and other specialty items at the action station and specialty bar. As an intern, I was able to try a meal at this cafeteria for free. There was an overwhelming amount of choices and the food was incredibly delicious. There were plaques by every choice with the macro-nutrients and calories listed as well as a healthy choice sticker by foods that fit the criteria. Not only do you have to wait in line to get your food or have it made, but you also have to wait in line to purchase it. The biggest drawback by far was the time it took to pay for your food. In the large cafeteria, at the peak of lunch time, there were 3 registers open. Each register took an average of 1-5 minutes to complete each order. Every food item had to be keyed in or scanned individually so lines of 15 or more people were common. In total, I waited in the line to pay, though my meal was paid for by BestHealth for Us, for 12 minutes. This is valuable time for a hospital employee.

Another opportunity I was grateful to experience as an intern was accompanying the Dietitians to speak to nurses about nutrition and BestHealth for Us. I learned that many of the nurses feel like they do not have time to eat. Some do not have time to pack a lunch and can’t make it to the cafeteria or one of the other restaurants to grab something because the lines are long. The other dining facilities offered are The Cafe, Cancer Center Cafe, Au Bon Pain, Starbucks, Chick-Fil-A, Subway, and Camino Bakery. The Vending Machine serves assorted sodas, chips and candy. Many of the nurses would like to focus on eating better but do not think it is feasible with their schedules and access to extremely quick and healthy foods and snacks.

Areas to Consider:

Having someone of credibility endorsing the vending machines might create better incentives for people to use. Having a “champion” of this project increases its potential reach, credibility, and visibility throughout the hospital systems. A few examples of this could be the president of the Wake Forest Baptist Health System, a celebrity, or the Governor of North Carolina.
Building relationships is key to promoting worksite wellness initiatives. Collaborating with other government agencies and with divisions within the hospital system and other hospital systems in the state can lead to supportive partnerships that can be used to expand worksite wellness programs. Relationships with vendors ensures that there will be a wide variety of options to choose from.
Stickers have power. Having different color options for stickers can be meaningful and potentially harmful. People do not want to feel discouraged or ‘wrong’ for buying something. A solid red sticker may feel incriminating and cause guilt. Yellow may also be too harsh. Our intent is not to shame people with what they eat, just make them more aware. A system of faces seems like a better choice.