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:
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.