Measuring Success in Community Nutrition

The University of Maryland Food and Supplemental Nutrition Education Program allows us to work with their educators throughout various locations in Maryland. I’ve now completed two weeks with this community nutrition program, and have never worked with the same age group twice. Teaching nutrition lessons to so many different age groups has led to a myriad of experiences with various teaching styles and energy levels!

In addition to varying energy levels, the participants’ ability to grasp your food and nutrition focused lessons differs. Some young children won’t retain more than the name of one new vegetable. Some adults refuse to taste new produce, or become frustrated and give up on a lesson involving reading nutrition labels. Success in community nutrition is measured on a small scale and increases significantly with repetition. It was difficult for me to see this in my brief experience, but I know that by the fourth or fifth lesson the children begin to categorize fruits and veggies on their own, and the adults feel more comfortable when confronted with nutrition labels.

One experience that taught me about measuring success was a “Read for Health” lesson with a play group. On this particular day, the children that showed up for play group were aged six months through two and a half years old. We had planned to teach the children about the different ways plants grow using the book Up, Down, and All Around. Suddenly our goals changed; our new plan involved allowing the children to experience new foods during the planned snack time and teaching the parents something new about how their children can experience new and healthy foods.

These goals may seem small, but they can also have a huge impact on the future of these families. Young children will typically try new foods when they’re offered. It’s important for a parent to see this for themselves and learn about how and why to diversify their child’s diet. Community nutritionists are confronted daily with a precious opportunity to influence diets and ultimately prevent chronic disease in low income populations through early nutrition education. It can be difficult to see this when looking at just one day, but small goals and simple changes add up and save lives.

The Big Easy Brunch - Success!

By: Lauren Hogan

After five weeks of preparation and much anticipation for the Big Easy Brunch at Riderwood, it was well worth all the hard work and long hours! From the beginning, the residents and cooks were very curious to know what foods would be included in our New Orleans theme brunch.  The residents’ feedback was much appreciated during the planning process to help us determine which foods were their favorites. “Original” beignets from Café du Monde were the hot topic and highly anticipated. I am also incredibly grateful for kitchen staff’s support. They not only provided great insight about where and how to promote the event, but they also assisted us as we maneuvered through the kitchen and used different equipment. This input from the residents and staff contributed to the overall success of the event, yet I had much more to learn about foodservice operations before completing my six-week rotation.

As a dietetic intern, my love of nutrition, food, and cooking makes the kitchen a comfortable environment for me, yet I found myself unsure how I might tackle a meal for 150 people. I must add that our menu involved some culinary techniques that may seem foreign the home cook. These new challenges included working with active yeast to make the beignet and King Cake dough. I quickly discovered how sensitive active yeast can be if the liquid ingredients are too hot. In addition, I learned how to make hollandaise sauce and the tricks to fix the sauce if the emulsion breaks. Lastly, the most daunting task of the entire event may have been poaching 150 eggs for the fried green tomato benedict. Luckily, there are a few nifty techniques that make poaching eggs feasible for even the home cook. Hint: steam the eggs in a muffin tin over a bath of water in the tilt skillet. After working with the kitchen staff through many different techniques, I certainly gained a new level of confidence in my culinary skills.

Overall, I am proud of all that we accomplished during our time at Riderwood. I am very pleased with our efforts to host such a unique New Orleans brunch for the residents. We received a lot of positive feedback from the surveys and staff. It would not have been such a success without the support of the residents and staff. I greatly appreciate the opportunity to work with the Riderwood staff and look forward to using my new skill set in the future.

Pictures from the brunch:

The Clinical Chronicles

By: Rachel Coury

If you asked me a year ago what I wanted to be when I grew up, I would have said “a community dietitian working to prevent childhood obesity.” But as I continue to move through different rotations in my internship, I’m realizing that there are a lot of different career paths out there that I could see myself following. It’s one of the perks of doing an internship that exposes you to many different areas in the field ;)

One of these newly coveted paths is clinical dietitian. I’m currently in my second week of my clinical rotation and loving it! And yes classmates I can hear your “I told you so’s” from here. You see, in the weeks approaching the start of my clinicals I may have been a tad on the anxious/nervous-wreck/annoying everyone in sight side. I asked my fellow interns who had already completed this rotation how they survived and if they always knew the answers to their patients’ problems. I thought it was going to be overwhelming and that I would feel inadequate. But as my first week in the hospital progressed, something great happened; I realized I was really enjoying myself! Sure it is overwhelming at first, but my preceptors remembered how it felt to be an intern and assured me its normal to feel like that. And yes there are a lot of things I don’t know, but it is rewarding and exciting to learn something new everyday. I feel like I’m really on the road to becoming a dietitian and am so thankful for this experience. So life lesson learned: don’t stress out about the unknown because it can be a pleasant surprise.

Indirect Calorimetry for Nutrition Assessment

By: Angela Farris, MA

I've spent 12 weeks of my dietetic internship in my clinical rotation. I was lucky enough to spend a few hours of my last day at the hospital in the Pulmonary Function Lab learning about indirect calorimetry. By definition, indirect calorimetry is the amount of heat generated in an oxidation reaction by determining the intake of oxygen consumed (breathing in) and the amount of carbon dioxide out (breathing out). Using the correct equipment and computer program, a range of calculations will be formed revealing useful information for dietitians.

I entered the room and was told to sit down in a chair and relax; any movement can alter the results. I answered provided simple questions like my age, height, weight, and sex. Next I was fitted with a mask and my nose was plugged. The machine was turned on and for the next 5-7 minutes I took normal breaths. This simple test revealed some interesting information!

Here are the results from my indirect calorimetry:

REE (Kcal/day): 1672 *REE=Resting Energy Expenditure, or predicted amount of calories my body burns each day.

RQ: 1.35 *RQ=Respiratory Quotient, or the ratio of carbon dioxide I released to the oxygen I consumed. Goal should be between 0.85-1. (I was told my 1.35 could be related to my carb-loaded breakfast of cream of wheat & fruit)

VCO2 (mL/min): 289 *VCo2=average rate of elimination of carbon dioxide

VO2 (mL/min): 213 *VO2=average rate of elimination of oxygen

Dietitians can utilize indirect calorimetry to get an educated estimate of their patient's exact caloric needs using REE. In Critical Care it is a golden rule to not 'overfeed' the patient. Using indirect calorimetry in conjunction with professional judgement can possibly lower the time a patient is critically ill. Just another reason nutrition matters! :)

Comparing Inpatient with Outpatient Nutritional Counseling

By Joyce Hornick, Dietetic Intern

My most recent rotations during my dietetic internship were acting as a clinical dietitian in a large community hospital, followed by observing dietitians in semi-clinical outpatient settings in cardiac care and diabetes care. This gave me the opportunity to see Registered Dietitians (RD) performing similar interactions with patients in two completely different settings.

In the hospital setting, patients are seen for various nutritional issues, many times at the request of the medical staff. The biggest advantage of inpatient counseling is the captive audience. The patient can’t choose to be elsewhere. The immediate needs of the patient can be focused on. For example, if a patient is in the hospital for hyperglycemia (high blood sugar), the immediate nutritional needs to help control their blood sugar can be addressed, along with how to prevent future events of hyperglycemia through an appropriate diet. Sometimes the patient has never been given the proper nutritional information or had received incorrect information. Many patients are appreciative of the information and are grateful for the time you give them to answer their questions.

Unfortunately, the hospital room isn’t always the best place to talk to a patient about their nutritional needs. Many different staff members are in and out of a patient’s room, giving minimal time to spend with a patient without being interrupted. A hospital RD may have more than a dozen patients to see in a day, so time must be used efficiently. Patients can be on many medications while in the hospital, which may make them drowsy and not conducive to listening to new dietary information. The patient may not understand what caused them to be ill, especially if it is a new diagnosis. They may be in denial they need help managing a chronic illness. For example, one patient I tried to talk to about how to manage his diet to control his blood sugar denied any need for help despite his being in the hospital to have a below the knee amputation due to complications from his diabetes.

In the outpatient setting, everything seems to be just more relaxed, less hectic, and at a slower pace. Most sessions are scheduled to take an hour, but most appointments went a little longer. Patients are usually referred to an RD by their doctor, which may or may not occur after a hospitalization for their illness. Typically, these patients are motivated to change how they manage their illness through diet. They’re tired of not feeling well and want to learn how they can change their eating habits to feel better. They want to change, but may not know how or just need reassurance from a professional that they can make the changes. A lot of patients have a family member come with them to the session for moral support. Fortunately, the point of outpatient counseling is to help you find your barriers to change and to help you remove those barriers. They help you set realistic goals that you want to achieve for yourself. They don’t set goals for you that they want you to achieve. They help you realize your self-empowerment potential.

The biggest negative of outpatient counseling is the No-Show. Many patients have good intentions when making an appointment, but sometimes just can’t follow through. Maybe they thought they were ready to talk about their nutritional and/or health problems, but get cold feet. It can also just be the fear of the unknown. If they’ve never been to a nutritional counseling session with an RD, they may think they are just going to be given a list of foods they can’t eat anymore. They may feel another person will be scrutinizing what they eat and judging them for their habits. From what I observed, this is definitely not the case. Any of the RD’s I worked with were non-judgmental. They listened to the patient and asked them questions. They did not reprimand.

Neither of these types of counseling is necessarily better than the other. They can complement each other. All RD’s in these settings want to be able to help people understand how nutrition plays a role in their health. As a prospective dietitian, I feel it is more important to see where I will feel more comfortable and best able to help people. Each setting takes a particular type of personality to do the job, placing the importance on fit rather than setting.

Fun Times with FSNE!

Unfortunately, this is my final week with the Food Supplement Nutrition Education (FSNE)Program. I describe it as “unfortunate” because FSNE has been one of my favorite rotations so far. I’ve enjoyed it so much because of the opportunity to work with inner city elementary and middle school children. Although working with kids presents unique challenges, like controlling a rowdy classroom on their first day back from Christmas break, I thrive off of working around kids and think it’s extremely important to teach them about health and nutrition early on.

The fabulous FSNE staff I had the pleasure of working with do a wonderful job at teaching nutrition education to the kids. Each educator is enthusiastic and engages the students in fun, interactive, and hands-on activities. Last week for a lesson with a second grade class I got to dress up like a chef and make an apple walnut salad with spring onions, dried cranberries, and raspberry vinaigrette dressing. The second graders cut their own apple and onion pieces and assembled their salad themselves. While they were having fun making the salad my partner, Rachel, and I gave a nutrition lesson based on a book they read in class called “A Feast for 10”. Our lesson and the book focused on eating family meals together. The children absolutely loved making the salad with their classmates and although none of them had ever tried this kind of salad before, everyone tried it and most said they liked it! I also got to try the salad with the kids and must say it was delicious!

Me in my chef's outfit holding children's books about nutrition.

During this rotation I have had a blast teaching kids about nutrition, and this week I’m looking forward to visiting a middle school and doing health, nutrition, and exercise activities with several physical education classes. Rumor has it we’ll be doing a food group relay race among other fun activities. I’m excited for it and I know the kids are too!

Supertracking the New Year

First and foremost I’d like to wish everyone a Happy New Year! I’ll admit that I spent a large portion of my time off sitting on the couch watching TV and eating refined carbs. Since I decided to let my diet and exercise routine go a little bit (okay, maybe a lot) and with the New Year here, I’m going to jump on the New Year’s Resolution bandwagon and get myself back into a healthy routine. The only problem with that is that there are so many things that I want to improve:

• Consistently eat well every day
• Drink more water
• Exercise more
• Get more organized

It’s a well-known fact that when making changes you should make goals attainable and only have one or two at a time. It looks like my plan to get back on track is a big undertaking to say the least.

This morning we held the Joint Class Day with several other intern classes in Maryland and Northern Virginia at the National Agricultural Library (NAL). We got to learn about nutrition informatics, the shift towards electronic health records, and just a smidge of what the NAL has to offer in terms of nutrition education materials. During lunch I even got to try on this suit that simulates twenty extra pounds in fat.

Our second presenter, a representative with the Center for Nutrition Policy and Promotion (CNPP), told us about a tool that I think will help me reach my goals (without overwhelming me too much!): USDA’s “Supertracker” at choosemyplate.gov. Everything that I want to do is offered on this website. And for free! CNPP made the Supertracker as user-friendly as possible and provided these six tabs to help you get started:
• Food-A-Pedia – To look up various foods
• Food Tracker
• Physical Activity Tracker
• My Weight Manager
• My Top Five Goals (And you can’t have any more!)
• My Reports

With a fresh start to the New Year and a new, easy and free online tracking system I’m thinking this will be easier than I thought. Special thanks to CNPP for coming to our Joint Class Day! I can’t wait to use this new tool!

Until next time,
Marion

The Blog on Blogging

Over the last few months, the University of Maryland dietetic interns, including myself rotation and write a blog entry for the class BlogSpot. I have written a few, but am still perfecting my skills. Now I am in my first week of information technology rotations and my first task is to write a blog on ways to make your New Years resolutions successful.

The blogosphere is HUGE and it seems like every one and their mom (literally) has a blog that they routinely post on. Well blogging really isn’t as easy as people think. I have found that a lot of time and thought goes into writing a post. You have to think about a few things including:

• Initially having a theme that you will be discussing in your blog. For example: nutrition, healthy tips, daily activities, etc.
• Understand who your audience is and write to them. Make sure what you are writing is realistic and relevant.

Now you say to yourself, all right am I ready to write yet? Nope not so fast!

• Figure out what the point is of what you're writing so you don’t go all over the place and stay on track.
• Make sure not to make it all text, add some white space, or insert bullets. This helps made your blog post look more inviting to the reader.
• Try to be short and sweet. Blogs are not meant to be novels. So get your point across and try not to go one forever. (The great thing about blog posts is that you can always post another if there is more information on the topic that you would like to cover.)
• Ok now you may begin!

That wasn’t so hard right? But there are definitely a few more things that go into these little posts than you would assume at first glance. Think blogging is for you? There are many websites that you can join and create your own blog.

• www.blogger.com
• www.blog.com
• www.wordpress.com

They are great for documenting travels around the country or world, keeping track of activities, or just daily life. And the best part is they are FREE! Enjoy and happy blogging!

Fueled by technology

Three weeks ago, I began my first information technology rotation at International Food Information Council (IFIC). IFIC is dedicated to communicating science-based information on health, nutrition, and food safety to the Public. In August 2011, I learned the importance of Information Technology and social media during our orientation week. A few of the things that I learned include: creating web pages, writing tweets and blogging. My rotation at IFIC widened my scope of learning and broadened my intellectual abilities in providing nutrition information to the public. I particularly enjoyed working with different professionals of diverse backgrounds. During the learning process, I attended a webcam interview, twitter chats and also wrote a blog for the web.

During my second rotation, I worked with the FNIC SNAP- Ed connection for my information technology project. SNAP-Ed connection provides dynamic online resources that can be used by SNAP-Ed providers and other users. After glancing at the SNAP-Ed website, I realized that I do not have to be an information technology expert in order to update the web pages. Many of you may not know that Registered Dietitians are responsible for updating the SNAP-Ed connection, WIC, Team Nutrition and others web pages. While I was at FNIC, I could work from mini to major projects such as nutrition through the season’s spotlights, health observance tweets, and entering data reviews using SNAP-ED. I learned that as a future dietitian, I can make a change in how nutritional information is accessed and delivered by incorporating my experience working with these wonderful organizations.

Since information technology has played an important role in improving the efficiency and productivity in all sectors of the dietetic professions, as a future dietitian I hope to master the technology tools while working as an intern. It is obvious that information technology will indeed play a large role in future trends of nutrition information and research.

By Betanya Alemu