D027 Task 2 E-portfolio Reflection Example

E-Portfolio Reflection: Teaching a Colleague About Pulmonary Embolism and Revising the Synthesis

Student Name

Leavitt School of Health, Western Governors University

D027: Advanced Pathopharmacological Foundations, Task 2

Course Instructor

Month Day, Year

E-Portfolio Reflection: Teaching a Colleague About Pulmonary Embolism and Revising the Synthesis

Introduction

For this portfolio I prepared a one-page synthesis of acute pulmonary embolism for a patient similar to one I cared for on our step-down unit, used it to teach a colleague and revised it afterward. I expected the teaching to confirm that I understood the condition. Instead, a 20-minute conversation showed me that I understood the pieces but had not connected them clearly enough for someone else to follow. This reflection describes the session, what it revealed, how I changed the synthesis and what I will carry into advanced practice.

The Teaching Session

I taught an experienced intensive care nurse who is also completing an advanced practice degree and has cared for many patients with pulmonary embolism. I chose this colleague because they would not accept vague explanations. We met after a shift, and I walked my colleague through the synthesis in the order I had written it: patient summary, pathophysiology, medications, non-pharmacological options and teaching points. I tried to apply what I know about adult learners, who learn best when new information connects to their own experience and solves a problem they recognize (Knowles et al., 2015), so I asked my colleague to recall a patient they had cared for as we went.

What the Conversation Revealed

Three gaps became obvious. First, when I explained right ventricular strain, my colleague asked why a patient whose blood pressure is normal can still be at risk. My synthesis described strain and troponin but never explained that a normal pressure can hide a right ventricle that is close to failing. I had to explain aloud that intermediate-risk patients need close monitoring because the right ventricle can decompensate quickly, and I realized that point was missing from the page (Konstantinides et al., 2020).

Second, my colleague asked why our patient was started on low-molecular-weight heparin rather than going straight to an oral anticoagulant. My synthesis listed both drugs but did not explain the sequence. I explained that an injectable agent is often used first while the patient is monitored for deterioration, because it is easier to stop or switch if thrombolysis becomes necessary, and that the oral agent follows once the patient is stable. Third, my colleague pointed out that I had written 'anticoagulants dissolve the clot' in my teaching points, which is wrong and would mislead a patient. Anticoagulants prevent the clot from growing; the body's own fibrinolytic system dissolves it over time (Freund et al., 2022). I had written the correct mechanism in the medication section and the wrong one in the teaching section, and I had not noticed.

Revising the Synthesis

I made four changes. I added a sentence to the pathophysiology section explaining that a normal blood pressure does not mean low risk when the right ventricle is strained, and that these patients need close monitoring for signs of decompensation. I rewrote the medication section to show the sequence and its reason: injectable anticoagulation first during the period of highest risk, then a direct oral anticoagulant once stable, with thrombolysis held in reserve for deterioration. I corrected the teaching point so it now says the medicine stops the clot from getting bigger and lets the body break it down. Finally, because my colleague found the patient summary crowded, I moved the imaging findings into a short list so the key numbers stand out. The revised synthesis is slightly shorter and, I think, much clearer.

Testing the Revised Version

Revising a document is only useful if the revision works, so I tested it. A week later I gave the revised synthesis to a newer nurse on my unit who had not seen the first version and asked them to read it in five minutes, then explain back to me why a patient with a normal blood pressure might still be at risk, why injections come before tablets and what the anticoagulant actually does to the clot. They answered all three correctly in their own words. That was a simple form of teach-back, but it told me more than rereading the page myself ever could. It also showed me one remaining weakness: they were unsure what 'provoked' meant in the section on treatment length, so I replaced the word with a plain explanation that the clot had temporary causes, the long car journey, recent surgery and estrogen, that can be removed.

The revision also made me look again at my sources. I had cited a guideline for the risk categories, but I had not checked it for the recommended monitoring of intermediate-risk patients until my colleague's question sent me back to it. Reading the guideline for a specific question rather than for general background was more useful, and I will use sources that way in future work.

What I Learned

The biggest lesson is that knowing a mechanism and explaining it are different skills. I could have answered exam questions about pulmonary embolism, but I had not built a clear chain from mechanism to finding to treatment that someone else could follow. Teaching forced me to make each link explicit. I also learned that errors hide in the parts of a document I think of as simple. I had checked the pathophysiology carefully and written the teaching points quickly, and the teaching points are what a patient would actually hear. Finally, I learned the value of choosing a colleague who would challenge me. A less experienced listener might have nodded along, and I would have missed all three gaps.

Application to Advanced Practice

As an advanced professional nurse I will teach patients, families and colleagues far more often than I did at the bedside, and I will be responsible for decisions such as when to escalate a patient who looks stable. This experience will change how I prepare. I will test explanations on a colleague before using them with patients, check patient teaching materials against the mechanism of each drug and write my reasoning about risk as carefully as I write the diagnosis. Clinically, I now pay more attention to heart rate, oxygen needs and right ventricular findings in patients with pulmonary embolism whose blood pressure is normal, because I understand why they can deteriorate. That change came from a single conversation, and it is the kind of learning I want to keep seeking.

References

Freund, Y., Cohen-Aubart, F., & Bloom, B. (2022). Acute pulmonary embolism: A review. JAMA, 328(13), 1336-1345. https://doi.org/10.1001/jama.2022.16815

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Konstantinides, S. V., Meyer, G., Becattini, C., Bueno, H., Geersing, G.-J., Harjola, V.-P., Huisman, M. V., Humbert, M., Jennings, C. S., Jiménez, D., Kucher, N., Lang, I. M., Lankeit, M., Lorusso, R., Mazzolai, L., Meneveau, N., Ní Áinle, F., Prandoni, P., Pruszczyk, P., . . . Pepke-Zaba, J. (2020). 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 41(4), 543-603. https://doi.org/10.1093/eurheartj/ehz405