Satisfaction in Patient Centered Care

By: Lauren Hogan

Since starting my clinical rotation four weeks ago, I’ve been pleasantly surprised by how much I’ve enjoyed the experience! Coming right out of college, I probably had the least exposure to the clinical side of the dietetic practice, and I must admit that I was pretty nervous to start. However, I have three words to describe the experience so far: engaging, fast-pace, and satisfying. It is inevitable not to be engage by the clinical environment. Every day I am deciphering new medical terminology, learning about surgical procedures, and challenging my clinical judgment. There is hardly time for a dull moment in the hospital setting—the patient population is diverse, and I am constantly seeing new cases and disease conditions that keeps me on my toes. Yet, the most satisfying part of my job is helping the patients set personal nutrition-related health goals. It is easy as a dietitians to decide what is best for the patient; however, my patients seem to get the most out of our sessions when they decide their goals. I then individualize the information, tools, and skills necessary to enable them to achieve their nutritional goals. In patient centered care, I feel that I have the greatest sense of the patients' needs and can better tailor nutrition education to meet their goals. 

The Importance of Family Meals

By: Angela A. Farris, MA

During my rotation at Montgomery County School Lunch I was able to teach a FSNE (Food Stamp Nutrition Education) lesson about the importance of family meals to an engaged group of 2nd graders. Together we read a book called 'Family Meals' which was about a young bunny named Hop-a-lot who found all of the benefits of eating together with his family. It turns out the kids already knew that it was better to eat with their family at a table than in front of the TV, but they agreed it was difficult to always make time with their families' busy schedules.

Here are a few of the benefits we discussed:

• We're more likely to eat healthy, complete meals when we eat as a family.
• You'll be able to talk more about your day and your feedings with your family members.
• You feel safe when you're with your family
• You're less likely to over eat if you're concentrating on eating dinner and not distracted by the TV.
• Eating as a family at home is less stressful than eating on-the-go in a car or at a fast food restaurant.

Here is a photo of myself reading Family Meals to 2nd graders!

Another highlight of my FSNE lesson was the when we were able to try a new food. This particular day the new food was....Pasta salad! Ingredients included raw eggplant, grape tomatoes, green bell pepper, whole wheat pasta, and italian dressing. Everyone received a bowl to try. The actual pasta salad received mixed reviews; but the goal was for each child to try something NEW which was certainly accomplished. Handouts were provided with the pasta salad recipe for each child to bring home to their family.

Old Ideas, New Ways

We’ve all been told before: eat your greens, eat your greens, eat your greens. When I was little, my mom used to tell me that if I ate my spinach I’d have big muscles like Popeye. My response was to push them as far away from me as possible. My mom also told me that I needed to eat carrots to “make my eyes bright”. My response: an exaggerated eye roll. Fast forward fifteen years and I’m spreading the same message: eat your vegetables (and fruits)! Lauren and I had the opportunity to give a presentation to the geriatric community about fruits and vegetables of various colors with the Food Supplement Nutrition Education (FSNE), a nutrition education program of University of Maryland Extension. Our curriculum was called “Health by Design” which explains the importance of healthy eating and how to incorporate it into your own lifestyle. What’s interesting about this program is that the first rule is “voice by choice”, which means that no participant will be called on and put on the spot. Each member of the audience can participate as much, or as little, as he/she wants. This creates an initial feeling that the room is a non-threatening environment. We talked about the benefits of fruits and vegetables broken down by color. We often hear we need to “eat the rainbow” of colors, and that’s exactly what we all need to promote good health and disease prevention. Food models were provided to show portion control and to show that there are so many different fruits and vegetables to choose from. The best part, however, was that we all got to try new ways to eat your veggies! We had mashed cauliflower and kale chips as a small snack to show that there’s no one way to incorporate vitamin-rich vegetables into your diet. Trying new recipes keeps it interesting and fresh! Who knows, maybe my seven-year-old self would have really liked the idea of kale chips!

My Community Rotation Reflection

I can’t believe I’m already half way through with my rotations. I recently completed my second community rotation at Food and Friends. Food and Friends is a non for profit organization that cooks, packages, and deliver food to people with HIV/AIDS and cancer in Maryland, DC, and Virginia. There are Registered Dietitians on staffs who provide nutrition assessments, complete home visits, phone counseling and educations to the clients. Some of the roles the dietitians performed that caught my attention were; the cooking classes and the nutrition education that were offered to the clients. The dietitians were so dedicated in teaching the clients in how to prepare a healthy meal, modify recipes, and general food safety.

Some of the things that I worked on while I was in Food and Friends:

Packing and delivering meals to clients

Assisting with a cooking class and delivering a nutrition lesson

Creating a food safety handouts

Developing and creating employee healthy challenge theme.

Participating in staff meeting

It was exciting to meet the clients face-to-face. After we did a couple of stops, I wondered how the HIV/AIDS clients would feel about the home delivery visit by different drivers and volunteers. I remember when AIDS was the elephant in the middle of the room that no one wanted to talk about. Virus carriers isolated themselves because of the stigma. This was the main reason why too many people were afraid to see a doctor or seek help from the community. Even though that we have seen changes in people understand of the disease, there is still a fear of the social disgrace of speaking about it and taking easy available precautions.

I am sure that living with HIV is certainly no walk in the park. Taking medication every day, doctor's visits every three months, and the fear that one day your health might fail are just some of the challenges people living with HIV/AIDS face. I can’t imagine how frustrating it must have been in the beginning of the epidemic, to be dying of something and not knowing what was killing you. Or even worse -- knowing what is was, but having a doctor tell you "sorry, there is nothing we can do." This rotation made me realize that today HIV/AIDS patients are aware of the disease process and are using community resources to stay healthy.

This rotation gave me the opportunity to work with excellent dietitians who inspired me to become more passionate about community nutrition. I learned that as a future dietitian, I can make an effective change in the health of society through community efforts. I also liked the reflection component of this rotation the best. The reflection component definitely set this rotation apart from other rotations I have done in the past. It will allow me to take this experience and apply it in the future.

RD to Be: Tips for success in your community rotation. If you want to be helpful in your rotation, do research on community resources ahead of time. Having a knowledge base about the population served by the organizations will let you brainstorm with your preceptor. I also suggest reading your facility’s community needs assessment reports and this will give you more information about the population you’re helping.

Comparing Adult with Pediatric Nutritional Assessment

By Joyce L. Hornick

In the fall, I worked at a community hospital as a clinical dietitian helping adult patients. In January, I got the opportunity to work as a clinical dietitian at a children’s hospital helping pediatric patients. Even though we’re all humans, the nutritional care of these two populations is completely different.

Estimating energy and protein needs of an adult follows systematic scientific equations. The energy and protein needs of most adults do not vary widely, from person to person or from day to day. The primary goal of calculating energy needs is typically to maintain current nutritional status if well-nourished, and to prevent loss of lean body mass. Even with chronic illness, needs estimation is relatively easy to achieve. Specific dietary and food recommendations are made depending on the diseases a patient may have and how they can use food to help improve their condition or prevent further progression of the illness.

In infants, the estimation process is much more complex, especially if the infant has a chronic illness or was born with a congenital or genetic defect. In older children and adolescents, the estimation process is still complex, though the rate of growth is typically at a slower pace. The primary goal of energy and protein estimation is to continue with a consistent upward growth pattern. It is very important to prevent trends toward a negative growth curve which could lead to Failure to Thrive. Depending on the type of illness a child has, their energy needs could be double what a healthy infant needs.

The energy needs of pediatric patients are based on their physical body weight. For a newborn, whose weight should be increasing typically by 25-30 grams per day, their energy needs will need to be evaluated every month to month and a half. If the chronic condition they have increases their metabolism, they may need twice as many calories to have optimal weight gains and their energy needs may need to be evaluated more often. Specific dietary and food recommendations are made much the same way they are made with adults. Though, since children tend to be pickier eaters than adults, there is a higher risk of malnutrition.

I was quite naïve upon starting my clinical pediatric rotation. I thought to myself, how hard could it be? Children are smaller than adults, but how much different can their nutritional needs be? In reality, their needs are much different than an adult. It was eye opening to see how detailed some pediatric patients needed their nutritional needs planned out. Children with special dietary needs due to illnesses need individualized care plans, just like adults, but the risk of malnutrition is much greater, making the care plan that much more important and even more detailed.

Life Doesn't End When Clinical Begins

As an undergrad at Penn State looking into dietetic internship programs to apply to, I specifically looked for programs that didn’t have an emphasis in clinical and didn’t spend too much time in the hospital. I had a phobia of hospitals and thought for sure I never wanted to work in one. “They smell bad,” “The patients are mean,” and “I’ll just get in the way of the medical team” were misconceptions I held. However, after graduating my beliefs about clinical dietetics shifted. I began to wonder if I had what it takes to work in the acute care setting of a hospital environment. Having absolutely no experience working in a hospital, I started looking forward to trying out my clinical dietetics skills during my internship.
But while awaiting the start of my clinical rotations, I kept hearing mixed reviews from other interns, both in the UMD program and in other programs, about what to expect. Some said it was extremely hard because you work long days and have homework and readings to finish along with mini case studies and major case studies. Others said their preceptors were really hard on them. More than one had mentioned that I should be prepared to cry during this rotation. Based off of these accounts, clinical was not something to look forward to after all!
However, some interns had a really positive clinical experience; so in my mind I kept an optimistic attitude and looked forward to tackling the challenges of clinical head on. When I started my clinical rotation at Union Memorial Hospital in Baltimore I went in with two expectations: that it would be tough, and that I would give it my best. Currently I’m in my 5th week working in the hospital, and this mindset has helped me immensely thus far. Based off of my experiences, I can say that clinical hasn’t been anything like the horror stories I heard from other interns!
These are the tips I have for future dietetic interns who are concerned about clinical rotations:

- Be positive. You will not have all the answers. Take criticism with a positive, can-do approach and an open mind. And ask lots of questions so you’ll learn the most from every experience.
- Be personable. I heard once that a patient isn’t going to remember all the details about the diet education you just gave them, but they will remember if you smiled and were friendly, which can sometimes make all the difference for them. Also, be friendly with hospital staff and your preceptors. Smile and say hello and don’t be afraid to loosen up and have fun!
- Prioritize. Clinical does have more work associated with it than other rotations, but it’s not unmanageable. Make sure you have a planner and write out when you need to do assignments and when they’re due. And if you’re less busy during other rotations get a head start on clinical homework.

Above all, remember that life doesn’t end when clinical begins. For me, this experience has been very insightful and I’ve found that I actually do have a knack for clinical dietetics and really enjoy working in the hospital. This is something in college I never would have guessed! You never know what you’ll discover by keeping an open mind and staying positive and organized. Good luck :-)

Importance of Brainstorming - Getting the Creative Juices Flowing

So here I was brainstorming on what to write my blog entry on this week and I thought about how often I have been brainstorming recently at during my IT rotations. I am currently in week 3 of my 5-week rotation at the USDA Center for Nutrition Policy and Promotion (CNPP) and loving every second of it. I always thought of myself as a semi-creative person, but have really impressed myself on the quality of all the projects that my partner and I have taken on over these last few weeks.

We have created:

• Tool Kits for events
• Multiple pilot programs
• National Nutrition Month Workplace Wellness Campaign
• Drafting scripts for a movie series

Over the last 3 weeks Sasha and I are constantly brainstorming and getting out creative juices flowing and adapting them to the projects at hand. I have learned so much and now understand the importance of getting multiple brains with different backgrounds coming together on topics and programs. Everyone within the Marketing and Communications Committee is always brainstorming and we attend at least 1-2 brainstorming meetings every day. I have really adopted an appreciation for everything that comes out of this branch of the USDA. Especially since it all started with a creative idea, which was then built up and revised on the thoughts of others to create an end result of things like the new icon MyPlate.

Wise Words for Incoming Interns

By: Sasha B. Bard, MSN

The internship continues to fly by. At the start of the program I remember people saying, “it’ll be over before you know it.” And they were right. We’ve already passed the half way point and graduation is only 140 days away!

After some reflection on the first half of the program, here are my top 5 tips for the incoming class (to be announced in April) that will follow in our footsteps:

-Practice what you preach. Eat breakfast, pack a healthy lunch, make time for physical activity, drink lots of water, and get a good night’s sleep. Life as a dietetic intern can get busy and between travel, homework, abstracts, research assignments, blog posts, and twitter it may feel like there is no time to take care of yourself. Finding time for you is a must!

-Make a good first impression. You don’t get a second chance with first impressions. As interns you will constantly meet new people and be thrown into new work environments. Treat each interaction as a job interview and put your best foot forward.

-Support each other. This is not a competition. The other interns should be your support and encouragement throughout the year. You are all in this together- your success benefits the group and vice versa.

-Make a Phyllis folder. You will constantly have forms and paperwork to turn into Phyllis, but you may only see her once a week since she’s running around town trying to keep tabs on all ten interns. Make a Phyllis folder and keep it with you at all times. This way, when she pops up, you’ll know exactly where to find your paperwork.

-Keep it light. My partner, Erika, and I do this well. We always have a good time in our rotations and have been told “we’re the most personable interns yet.” It’s important to smile and find something to laugh about. Enjoy your experiences and, possibly more important, make sure your preceptors enjoy theirs as well.


Check back in June for part two: More Wise Words for Incoming Interns.