Tuesday, February 9, 2016

Turnips on the Terp Farm

Elizabeth and I had the privilege of visiting the Terp Farm last week as part of our sustainability rotation. Our experience there was both rewarding and educational. In addition to helping out with the harvest by picking out, cleaning, and packaging turnips for the 2016 Taste of Maryland Legislative Reception, we were also given a lesson on Terp Farm’s history, mission, and impact by Guy Kilpatric, the farm’s lead agricultural technician and cultivation expert.
Terp Farm, located in the Upper Marlboro Facility of the Central Maryland Research and Education Center, shares a 202-acre plot with students, faculty, and volunteers from the University of Maryland’s College of Agriculture and Natural Resources, Department of Dining Services, and Office of Sustainability.
As we learned, the goal of Terp Farm is to become a fully sustainable operation in all senses of the word. The ecological footprint of Terp Farm is reduced through environmentally sustainable farming methods, such as crop rotation and use of organic herbicides and pesticides. Guy showed us his impressive farming plan, which incorporated dozens of different crops rotating through a relatively small 2-acre plot without any overlap through a four year timeline. In addition to extensive planning and careful considerations of cover crop usage, plenty of sweat and hard work is required to maintain the health of the land. The vegetables planted in the Terp Farm greenhouses all use the no-till farming method, which is a strategy for preparing a seed bed with minimal damage to the soil. Instead of pulverizing a large amount of earth into fine particles with the use of large machinery, Guy painstakingly breaks apart clumps of dirt with a broadfork, being careful not to destroy the structure of the soil. This method not only increases the soil’s nutrient retention and resiliency, but also health and yield of the crops.
We also learned that Terp Farm ultimately seeks to serve as a “residency” program for the next generation of America’s farmers. As Guy explained, over four million farmers in the United States are within five years of retirement and need to be replaced to maintain agricultural productivity. However, Terp Farm puts a positive spin on this otherwise insurmountable statistic. By providing the training grounds for students to become prospective farmers, Terp Farm reduces labor costs while offering an immersive and all-inclusive education to those that come to work in the fields and greenhouses. This method of integration into the community results in widespread social impact while maintaining financial autonomy.

While our time at Terp Farm was short, we learned so much and were glad to be a part of this amazing and fantastic project at the University of Maryland. Consider paying the Terp Farm a visit for yourself or even volunteering for a day to get a sense of what goes into running a sustainable farm operation!

Monday, February 1, 2016

New Year, New Rotation

This year, on the first week after winter break, I started my longest rotation: clinical! I got assigned Franklin Square Medical Center. I was somewhat apprehensive, because of the tales I've heard from past interns, but mostly I was excited for the new experience! On the first day, I was fully prepared and walked in bright and early with my lab coat, calculator, binder, notebook, pens, highlighters, and everything else I could think of to prepare myself. 
400 bed hospital

My preceptor was very welcoming. She helped me get a badge, introduced me to the other dietitians, and gave me a brief tour of the hospital. I was given my own computer station, since this will be an eight week rotation (followed by an additional two weeks of staff relief, working by myself!) We started out slowly, with me observing her as she met with patients and wrote notes about the consults. She asked me anatomy and medical nutrition therapy questions, so I'm very glad I had homework and class days for review! My first preceptor and all the dietitians are very knowledgeable, and were able to list facts for every disease state we encountered. I strive to reach that level of thorough knowledge, which I know will come with more years of experience.

Gradually, my duties are being expanded and my responsibility at the hospital is growing. One of the first things I saw was how they actually decide which patients to see. At this hospital, patients are seen if a nurse asks for a nutrition consult, if a doctor asks for a consult, if a patient has been in the hospital for more than 6 days, if a patient has been on a liquid diet for 3 days, or if we are following up on a past patient. Each day, I get a printout of the patients and use colored highlighters to screen who I need to see. So far, I've also learned how to read medical charts (paper and electronic), how to decipher lab values, how to read radiography notes, and how to present a patient's history. One of the most important skills that I'm developing during this rotation is the ability to read a large amount of information and pull out which pieces are relevant to the nutrition problem, diagnosis, and interventions. For my first few assessments, my preceptor came into the room with me to observe, and she occasionally interjected if I forgot something. I was surprised by just how quickly it felt natural, and soon after I started seeing patients by myself and writing the notes alone, then reviewing them with the preceptor to make any necessary edits before she signs off on them so I can add them to the official patient chart.
An example note that I wrote after seeing a patient (no private information on this page)

So far, I've shadowed a dietitian on the general floor, surgical floor, and oncology floor. Next week I'll begin cardiology and renal. I'm really enjoying each new assignment, and my binder of notes is growing quickly! To all future interns who are nervous about clinical, don't be! Prepare yourself in advance by brushing up on your MNT, and then be excited! It is a fantastic feeling to put all your education to use, meet patients, and have the ability to make decisions that actually affect and improve their outcomes. 

Thursday, January 28, 2016

How We Escaped to Hawaii before #Blizzard2016

co-written by Valerie Agyeman and Kelda Reimers

It was the night before #blizzard2016 when we were decorating for our theme meal at Riderwood. As we were blowing air into balloons, putting up colorful streamers, and hanging tiki totems all around the dining room, our biggest concern was how we were going to host a successful theme meal before we got snowed in at Riderwood. Thanks to the snow gods, we were able to “escape” to Hawaii and back to our homes before the historic blizzard arrived in Silver Spring, Maryland.

It really feels like we just began our rotation at Riderwood. Six weeks goes by very quick when you are having lots…and lots of fun! We have learned so much during our time at Riderwood -- we practiced our culinary skills, planned and marketed a theme meal for residents, and managed our time to make sure all projects and tasks were completed. As we began to brainstorm ideas for our theme meal, we came up with several but we were encouraged by Chef Chad, and John Porter to come up with a theme that had a unique history, unique food, and could attract the residents! After a lot of brainstorming, we finally decided to host a Hawaiian theme meal. Why Hawaii? With cold temperatures in Maryland, our goal was to get resident's minds of the weather and escape to a warm, fun, place… which was Hawaii! That wasn’t the only reason why; we felt that Hawaii had very unique foods, and with Hawaii becoming the 50th state in 1959, residents would recall that amazing event. After our theme meal was approved, we ran with it and put in all the effort that we could to make sure it was a big success! 

We had so much fun looking at recipes, but it wasn’t until we started working in the kitchen that we realized how many variables are in play at each meal service. Working in the kitchen allowed us to practice our culinary skills and become acquainted with the staff and environment. Leading up to our theme meal, we had to work diligently to stay on top of our tasks and keep organized. Developing production sheets and maintaining to-do lists kept us on task and helped lower our stress. Challenges occurred along the way but the kitchen staff helped us overcome them! We are so grateful to have worked with an amazing team in management as well as the kitchen. We have gained many skills that we will use in all aspects of our careers and personal lives. Thank you to all who played a role in making our time here at Riderwood a huge success.


TV Commercial: http://bit.ly/1ZHRHEZ
We produced flyers, handouts, and even a TV commercial to help market the meal to the residents of Riderwood. The week before our theme meal, we went to three restaurants: Windsor, Seasons, and Fireside to market our theme meal before dinner time. With Hawaiian leis around our necks, we got festive as we sampled pineapple upside down cake (one of our theme meal desserts) and some Hawaiian punch each night. This allowed us to interact with Riderwood residents, and get some feedback on our dessert. We even got to hear a lot of great stories from residents about the time they visited Hawaii.

Theme Meal flyers, handouts, table tents
Sampling pineapple upsidedown cake at Windsor restaurant

   Week of Theme Meal

During the week of our theme meal,  we performed a thorough inventory of our ingredients in dry storage and the walk-in freezers/refrigerator to make sure we knew where everything was in advance. We then received our produce and meat orders from the vendors, prepped and cooked our dishes following our production schedule. Some of our prepping included: cutting banana leaves and wrapping around the fish, chopping onions and hundreds of garlic cloves (!!), peppers, and chicken for our Hawaiian kebabs, and cutting and washing baby bok choy!

Day of theme meal

The event was a hit! Our goal was to serve 100-120 people and we ended up welcoming almost 160 guests -- many of whom showed up wearing their own Hawaiian attire. Residents enjoyed the different dishes we offered especially the teriyaki-chickpea loaded sweet potato and the mai tai punch we made! We administered surveys out solicit feedback, and chatted with many of the attendees while they dined. After the whirlwind of our week, we were able to hop into our cars to race home just as the snow was beginning to pick up....and #blizzard2016 officially arrived.

  The entire process of planning a theme meal required flexibility, a lot of patience and hard work.
  We now have a new perspective on how much planning and cooperation (not to mention man-      hours!) go into food service production at such a large scale. Thank you for welcoming us,    Riderwood!

A quick selfie with our fabulous hairnets!


Monday, January 25, 2016

Want to be a NICU dietitian??

UMD interns are fortunate enough to be able to spend two weeks at Children's National Medical Center (CNMC) in DC. A few months ago, each intern had the opportunity to choose a team of dietitians to rotate with each week.There were various options in both the inpatient and outpatient settings, working with preterm infants to early-teens. I choose to spend a week in the neonatal intensive care unit (NICU) and the second week with the intestinal rehab dietitian.

I have just finished my first week at CNMC with the NICU dietitians. I will admit, the night before my first day I did not sleep much from nervousness and anxiety. I did not have a clue how I was going to react to seeing such critically-ill babies. Even though I had prepared beforehand and completed all study guides and homework assignments that were assigned, I still felt overwhelmed by infant nutrition and thought I was way in over my head. Once arriving to the NICU and meeting the dietitians, we jumped right into rounds and the nerves were gone immediately. It was all exciting, fast-paced, and interesting. I felt that two hours of rounds were not enough, I wanted to keep learning about all the cases and of course look at all the cute babies. 

But I must say, sick babies are not for everyone. These babies may have life-long complications, have gone through multiple surgeries at only a few days old, and could be spending months in the unit before being able to go home to their family for the first time.

(image taken from Google images)

Realizations I made when working in the NICU:
* Fluid is so important! It is closely measured and monitored.
* Most everything is measured per weight of infant in kg. For example 100mL/kg/day
* Neonatal nutrition is heavily reliant on parenteral nutrition. CNMC NICU dietitians have the ability to adjust PN components and values. Not all dietitians in facilities are able to do that, it is usually pharmacy who compounds PN.
* Hospital stays can be months long. One of the dietitians started at CNMC in July around the same time a NICU baby was born. That baby was not discharged until October!
* Formula? Breast milk? Donor milk? It's a whole different way of thinking. Its not food, like we are used to dealing with.
* The babies can't talk to you! You might think "well duh" but coming from a clinical rotation in the adult population where if you have a question or want to know how your patient is feeling you could just ask. With babies you can't and it just hadn't dawned on me. Instead the babies may cry or make other noises that can tell you something. There are also times where baby's parents are available at rounds but they are usually just learning about their baby like we are! The only time a dietitian will interact with the parents is to discuss or educate the parents on feeding.
* Labs and growth measurements are usually documented daily. A great way to be able to trend how the baby is doing.

(A poster created by the nursing educator providing education for the NICU nurses about the importance of nutrition in growth and development) 

What I loved about working in the NICU is what an important role dietitians play. These infants need nutrition within 24 hours of birth, and the doctors, nurses, parents, and the babies rely on the dietitians to fulfill that requirement.

Sunday, January 17, 2016

Nutrition for Kids: A Whole Different Ball Game

This week, the University of Maryland Dietetic Interns got the opportunity to attend a joint class day at Children's National Medical Center (CNMC).  A joint class day is an opportunity for students from several internships come together to focus on one topic for an entire day.  These class days are extremely enriching and a big benefit of the UMD College Park program.

This particular class day is required for interns if they want to complete a rotation at CNMC.  While listening to the presentations, it was easy to see why this class day is required; childhood nutrition is so different than adult nutrition, it truly is a different ball game! Since all UMD interns spend two weeks there, we packed in our cars and headed to DC!

My first impression when I got there was what a nice facility it is. They do a great job of making the whole building feel warm and inviting for all the children that enter through the doors.

This snuggly stethoscope bear can be found all over the hospital!

These hot air balloons make the hospital feel warm, welcome and fun for all the patients.

It was so much fun to look around at the colors and the artwork throughout the hospital.  We didn't have long however, because we had a LOT to cover in this joint class day.  Nutrition for children is so different than nutrition for adults.  As one of the speakers explained it, "You cannot think of children just as smaller adults because they are going through the process of growing.  While you may be trying to maintain an adult's nutritional status or weight or even help them to lose weight, children should always be growing".  This makes adequate nutrition absolutely imperative for children, so the day's agenda was serious business!

                  We weren't wasting any time at this joint class day!

What I found most interesting about the day was how many different formulas and products are used for children that I had never even heard of before. Though I took Nutrition Through the Life Cycle in my undergraduate career, you never get so specific about those kinds of things and it was really neat to see such a specialized area of dietetics.  

Some preterm formulas we learned about at CNMC.

It was also neat to hear about nutrition for premature babies, how important it is, and how much nutrition can help a baby that was born early.  The dietitians at CNMC are highly respected and valued employees that can offer a lot of help to all the babies, kids, and teens that come through the hospital.

This class day was amazing exposure to yet another area of dietetics that us interns could have the opportunity to contribute to come the end of June (when we graduate!).

Wednesday, January 13, 2016

Seeing Clinical from a Different Perspective

Going into this internship, I was always afraid of clinical. I think every dietetic intern is nervous about clinical at point or another. My clinical rotation, however, has been a special one so far. Most interns do their clinical rotation in a hospital setting but I have the unique privilege of beginning in a long term care facility.  I also have the to opportunity to start with two different preceptors at two different locations. My two locations are the Villa Rosa Home and Riverview Rehabilitation and Health Center. Both of my preceptors are passionate about their work and are the best at what they do.

I am currently at Villa Rosa, three days a week and Riverview, one day a week. This is only for four weeks before I start my rotation at the Baltimore VA. Only one week has passed and I feel like I have learned so much. I also found out that clinical isn’t as scary as everyone says it is. My preceptor at Villa Rosa, Stephanie Krimmel is a fantastic RD. She explains terms to me and is patient when I don’t know something. I have a lot of notes just from one week there. 

I typed up several nutrition notes and she supervised my progress. On my last day there last week, I got to see a swallow evaluation. The speech therapist, Katie explained to me what she was doing and I saw how much dedication goes into one evaluation. The speech therapist has to persuade the resident into eating several things and she watched for movement in the throat and jaw. Katie also had her hand against the resident’s throat to feel for swallowing. I can really see how RDs and speech therapists working together is essential. Next week, I get to observe  wound rounds. Thankfully, I am not squeamish around blood so I am looking forward to this.

At my second long term care facility, Riverview I met Cheryl Frazier. She is also a fantastic preceptor. I am so glad that they are my preceptors.  Cheryl introduced me to everyone as we made our tour around Riverview. It is a much larger and busier rehabilitation center than Villa Rosa. It was remarkable to see how vastly different the two facilities were. At the Maryland Dietetics in Health Care Communities fall meeting, there was a session on transforming the dining service in long term care centers. They handed out trays, and gave menus that looked like you were dining in a five star restaurant. Riverview is one of the facilities where this style of dining service is being implemented. The chefs launched a new menu for the Riverview staff to try. Cheryl and I took pictures of it for Riverview. We also got to try a few things and I have to say that it was excellent. From the cornbread stuffed pork to the salad everything was delicious.

Overall, my experience at these two places were eye opening and made my transition to clinical feel effortless. I really appreciated that both my preceptors took the time and patience with me. I went into clinical having an open mind even if I was nervous. It really did pay off because now I enjoy it and am willing to step outside my comfort zone.

Saturday, December 12, 2015

Finding Your Voice Through Podcasting

The University of Maryland, College Park Dietetic Internship is one of the only programs with a nutrition informatics emphasis. I am very happy to be a UMD Dietetic Intern, especially because I have so many opportunities to enhance my technology and communication skills. Whether I am learning about different coding languages such as HTML, managing an e-portfolio, or rotating through different facilities like the Center for Nutrition Policy and Promotion (CNPP) or a long term care facility, I always run into nutrition informatics in every areas of the dietetics practice. 

During technology days at UMD, Interns work on e-portfolio websites, learn about different tech tools, listen to guest speakers present on topics related to informatics, and more! Every couple of weeks interns have to meet e-portfolio milestones which includes things such as adding content about rotations, posting a resume, or embedding twitter widgets to personal websites. One thing I have never done before this internship began was record a podcast. As a part of our e- portfolio milestones, we have to record a podcast on an interesting topic and post it to our websites.

The homepage of my e-portfolio website

My first podcast is on the current malnutrition issues in Ghana, West Africa. This was a great learning opportunity for me especially because it allowed me to research and gain more knowledge about malnutrition and how it affects not only mothers, but children as well. Researching this topic exposed me to the many international public health organizations and how they work together to combat malnutrition in Ghana and other developing countries. I enjoyed it, and can't wait to record my next one!

There are many kinds of audio recording softwares to choose from, but UMD interns choose to use Audacity. Audacity is a free, easy to use multi track audio editor and recorder for Windows, Mac, and other operating systems. For a beginner like me, this is a great software to use.

Here are some podcast pointers before you get started:

Inspiration. Listen to successful podcasts. This is helpful for those just getting started.

Provide information of value. Value can come in the form of education, information, inspiration, motivation. Record on a topic that is trending in the dietetics world!

Time. Create a podcast that is not too long or not too short. Give listeners a reason to come back.

Be enthusiastic. Find your voice, add some excitement to your podcast, be energetic not monotone.

Market yourself. Post your podcast on your website, mention it in your email signature, promote on social media.

Whether or not podcasting is your thing, it gives you a chance to practice your communication skills; a skill necessary in the world of dietetics. Research a topic that excites you, find your voice and give it a try, you never know who is listening.

Listen to my first podcast, Malnutrition in Ghana!
Follow my Internship experiences on Twitter at @ValerieAgyeman