Clinical Rotation: Mini Case Study

Five weeks ago I was both excited and nervous to start my clinical rotation. This rotation is completely different from all the volunteer/work experience that I have had in the past. The clinical rotation requires the interns to learn a lot of medical terminology, food/drug interactions, medications, electronic medical record system and able to complete a full nutrition assessment/counseling in a hospital setting.

Last week I presented my mini case study and this is one of the assignments that every intern must complete halfway through their clinical rotation. For the mini case study the intern provides all aspects of the nutrition process similar to that of a Registered Dietitian for the patient, performs the initial nutrition assessment, provide any interventions and follow up on the patient’s progress. Other things to include in the case study are background information, past medical history, past surgical history, nutrition requirements, lab values, procedures, medications and nutrition focused physical findings.

Here are some tips that I have picked up on after presenting my mini case study to six clinical preceptors and my internship director:

1.     Be prepared to answer questions.

2.     Know your patient well --review drug/nutrient interactions, any procedures that might affect the plan of care and any social issues.

3.     Provide information on your plan of care if you were not able to follow up on the patient.

4.     Remember to use the nutrition care manual and the evidence analysis library to review the current literature related to the case.

I must say, now I feel completely comfortable working in the clinical setting! Some things that really helped me prepare myself for this rotation were the intern class days and the homework assigned each week. Compared to the first week of the clinical rotation, I am proud to say that I have improved immensely. I have provided heart healthy diet education, heart failure diet education, diabetes education, Coumadin education, charted nutrition assessments and provided recommendations for enteral and parenteral nutrition. I am excited to complete the remaining portion of my clinical rotation. Time to find my major case study patient!

FNCE Reflections -- Margery Swan

Several weeks ago, I had the opportunity to attend the 2012 FNCE (Food and Nutrition Conference Expo) in Philadelphia and sit in on multiple educational sessions.  Since I’m still a relatively new social media user, the session I chose to go to was:

“Time to Socialize: The Ins and Outs of Facebook, Twitter and Linked In”.

Both speakers, Bonnie Taub-Dix and Keri Gans have a background in social media and have successfully used it to promote themselves professionally.  The first application, they discussed and the one I was most interested in, as a new member, was Twitter.  Through their presentation I learned that you can send a direct message through twitter (only the recipient can see) and that there are applications available to combine the different social media platforms.

Hootsuite, for example, allows you to post/tweet things simultaneously and has a built –in option to shorten URLs when tweeting.

During the session they also talked about the differences between a professional and personal Facebook.  They suggested creating a professional page if you want to create a brand or if you have your own practice.  They also recommended the following tips:

1)      Try and make your Facebook and twitter look similar to enhance your brand.

2)      Don’t be afraid to promote yourself – Facebook about your blog or tweet about your Facebook.

3)      Follow up with friends and followers whenever possible and answer any questions.

One of the last topics was Linked In.  This was something I was curious about because I have not yet created a Linked In account.  This is because I didn’t really understand how to use Linked In or how it would benefit me as a professional. During the discussion, I learned that Linked In is an important tool to connect with other professionals and to promote yourself.  Linked In members can also join discussions and post questions to different professional groups or categories. 

So, the message here, don’t be scared to experiment with social media, the pay-off can be huge and it’s a great way to connect with people, while still promoting yourself and your business.

FNCE Reflections -- Mavis Ren

As a dietetic intern one of the best opportunities is to be able to attend the 2012 Food & Nutrition Conference and Expo (FNCE) in Philly this year. Along with the Expo with many different companies showcasing their new products; there were also around 10 lectures going on at the same time. I learned a lot while I was in Philly and now I will share some information from one of my favorite sessions that I attended that weekend. One of the sessions was titled:  “Calling All Food Bloggers: Stay in the Game”. I chose this session because my internship has a focus on information technology and I learned a few basic blogging tips that will be helpful for me to start my own blog. Here are some of the blogging tips that I learned during this session:

 

 

 

 How often should you blog?

Along with our full time jobs many people do not have the time or opportunity to blog daily. One option is to create the blog post, save it and then schedule the post date on your website so that it automatically updates for you. One thing that I learned is that time to post a blog that will attract the most viewers is on Wednesdays or Thursdays.

 How long is the post?

Blogs are generally short, understandable, does not have to be in essay format because people typically skim through blog posts on the web.

 

Research

Stay updated on current research! It will help to cover yourself so that you provide accurate information on your blog posts. Find research from literature, magazines, journals and recent research. It does not have to be reported in research format, set your own tone.

 

Format

Write about things that matter to you and have a consistent format for blogging. Provide pictures if you are giving sample recipes and it does not have to be a professional photo.  Try opening a forum at the end of the blog to generate more comments on your post and see what readers have to say.

These were only a few topics covered during the lecture on how to create a food blog. I found these very helpful for me and will definitely consider these key points/tips while I create my first personal blog.

Posted on behalf of Mavis Ren

FNCE Reflections -- Nikki Bolduc

For my second blog post, it couldn’t be more appropriate to re-cap the 2012 FNCE session “Time to Socialize: the Ins and Outs of Twitter, Facebook and LinkedIn.”  In this session, Bonnie Taub-Dix, MA, RD, CDN and Keri Gans, MS, RD, CDN gave a comprehensive summary of Twitter, Facebook, LinkedIn and Pinterest and exemplified how each of these social media avenues can contribute to your career as a Dietitian.   

Starting with Twitter, Bonnie and Keri explained how this social media outlet is a “conversation” that cannot be ignored.   Twitter can connect people through interests, groups, and hot topics.  They recommended using TweetDeck to write your tweets, but admitted it is not recommended for use on your iPad or iPhone.  In which case, they recommend using HootSuite or Echofon. 

Facebook can be a great tool for communicating your business vision by posting articles, events, and professional accomplishments.  However, Bonnie and Keri cautioned us that it may be appropriate to have a personal page and a business page in order to market your professional brand more accurately.

LinkedIn is a business tool that is similar to Facebook, but with more opportunities to market yourself as a professional.  Your LinkedIn profile is much like a resume.  Bonnie and Keri also explained that you can become part of a group to ask questions and start a dialogue. 

Last but not least, Pinterest is recent phenomenon that is based on visuals.  Pinterest is a great way to draw traffic to your blog or website.  You can post pictures, create contests, sell products, and generate revenue while creating a brand.  “Boards” allow you to gather a number of related pictures to showcase your talents and/or interests for others to see and be inspired by.    

  
I hope I have inspired you to get involved with one or more of these social media tools like Bonnie and Keri have inspired me.  With the way social media is exploding, Bonnie and Keri say, “you can’t afford not to be involved.”                                                                                                                                          

Posted on behalf of Nikki Bolduc                                                                                                                    

FNCE Reflections -- Amy Bortnick

You know you attended a good presentation when the information excites and makes you feel compelled to act right away!  After attending the 2012 FNCE session: “A Call to all Food Bloggers: Stay in the Game” by Toby Amidor, MS, RD, CDN & Dana Angelo White, MS, RD, ATC, , social media and nutrition role models with awesome blogs (linked above) my mind was buzzing with inspiration and new inspirational ideas. In fact, after the session, part of me wanted to leave the conference, find a computer, and get to work…but don’t worry I held it together and didn’t act on the urge until now.

 I want to share the cool tips I gleamed from these cutting edge dietitians that will be useful to anyone with a desire to improve or start a blog. I am also going to let you in on the specific bits of advice I personally plan to incorporate into my own blog upearlywithamy.com ASAP!

 Helpful Blogging Tips:

·         Post regularly and be consistent, one of the best ways to keep people coming back to your blog is to give them regular posts to come back to.  

·         Invest time; if you want to have a good blog, like anything else in life, it takes time and hard work. Decide if you’re dedicated to blogging and then make the commitment by setting aside time on your schedule and physically writing it in your planner.

·         Short and Sweet; You don’t have all day to write and people don’t have all day to read, keep it short, sweet, and informative. Aim for fewer than 500 words per blog and one idea per paragraph.

·         Keep an Idea log: Ideas for blogging come about at all different times in the day. Keep a pad or digital lab where you can write down your ideas. Even if you don’t take action right away, keep them on the back burner for later use.

·         Do the research: When you write as a nutrition professional or healthcare provider your reflecting your profession in your work so be creditable.

·         Get the Statistics; Blog hosting sites like wordpress.com and blogger have statistic pages that help you gather detailed information about your posts and readership so you can see what truly draws people to your blog. Google Analytics is a great example.

·         Focus on photography: We are visual learners; by including pictures in your blog it will become more attractive to readers. By taking shots at an angle, using color in the background of your shot, and adding bits of garnish to your food dishes you can really enhance your photos.
 

I personally decided to begin a consistent weekend post, I’ve already downloaded Google analytics, and I created an excel spreadsheet to keep my new ideas and schedule my blog posting.

What will you do to enrich your blog today?

Posted on behalf of Amy Bortnick

FNCE Reflections...

Our interns had the wonderful opportunity to get to attend the Academy of Nutrition and Dietetic's Food & Nutrition Conference & Expo (FNCE) in October.  Our interns had a great time and have written blogs about their experiences.   Check out what our interns learned!

Note: our internship has an emphasis on information technology so several of our interns learned a great deal from the social media sessions that they attended.  Each provides a different prospective on those sessions!

"I Will Never NOT Ever Eat a Tomato" -- How Picky Eaters Can

Getting kids to eat NEW fruits & veggies can be a challenge, but engaging these same children in food  prep can enhance their chances of tasting a fruit or veggie for the first time, or maybe the second or third time.  Often it takes many "tastes" of a "new" food until we like the flavor.

UMCP Dietetic Internship participates in a Maryland-based SNAP-Ed program, and utilizes "Read for Health" curriculum with food prep at Baltimore City's Baybrook Middle School at an After School Program for elementary and middle school students sponsored by Child First Authority.

 

This past week - we read a book entitled - "I Will Never NOT Ever Eat a Tomato" and discussed how big brother Charlie helped little sister Lola learn to eat new foods.  We shared how we helped our younger brothers and sisters to eat new foods.  During the book we tried to guess what mystery fruits were in brown bags by putting our hand in and giving each fruit a "good squeeze".  We had the most trouble guessing the fruits - Pomegranate and Avocado.  Many of us had never tried these fruits before.  We were hesitant with the idea about tasting these new fruits.

But once we started with out food prep - we were so focused and excited.  We wanted to try everything we made.  Our younger children pulled grapes and cut up bananas, while our older children cut avocado, mango, and pineapple into smaller pieces.  Our leader then added pomegranate seeds to the bowl and it was time to eat.  Our fruit salad included pomegranate seeds, banana, red grapes, mango, pineapple and avocado.  We all tried at least a little bit of everything and several of us really liked the new fruits with others being neutral.  If you get a chance -- listen to the YouTube version of this great book, so you too can learn all about eating new fruits.  Eating new foods can be fun!

Posted on behalf of Phyllis McShane

The D.C. Experience: Food Truck Fridays

by: Melissa Grindle

One of the curses and blessings of this internship is the travel.  I've chosen to embrace it rather than fight it, and as a result my partner Wendy and I have been able to experience and enjoy each setting we have rotated through.

This past week, we wrapped up a rotation in D.C. at the International Food and Information Council.  The commute what a bit of a bear, but I’ll speak on Wendy’s behalf and say we really enjoyed the experience and the environment offered at IFIC.  Plus, right around the corner from the office were food trucks!

We had our first food truck experience when we attended the Funky Fresh Foodie Fest in August, honestly, we haven’t looked back. 

Quickly, we instituted Friday as “Food Truck Friday”, and sometimes we enjoyed a “Food Truck Thursday” just to switch it up a bit.  I believe Wendy and I are proof that Phyllis (our director) has a knack for pairing up interns because our personalities mesh so well, and we both have a love for gyros. 

Our food truck Fridays were a treat at the end of the week and were a great way to get some fresh air during our lunch break.  We also aren’t city people, so exploring DC for a bit was welcomed.  

The amount of food you can get at a food truck is unbelievable for the price.  Unfortunately it comes with the inevitable droopy eyes after lunch.  Well worth it in my book though!  We tried everything from gyros, to tacos, and even cupcakes.  We may or may not have indulged in a little frozen yogurt on a warm fall day.

Insert jokes about getting a variety of colors in your diet…

As dietetic interns, we enjoy food and enjoy exploring new places to eat.  This rotation offered us great experiences both in and out of the office!

Till the next Food Truck Friday…

Diet Education 101

I commonly get asked: 

What is the role of a dietitian in the hospital? 

This is not exactly an easy question to answer because I have learned the role of a dietitian varies in every hospital and among different types of dietitians. However, one role universal to dietitians in most hospitals is providing patients with diet education.

In entering the fourth week of my clinical rotation at Carroll Hospital Center and I have already begun educating patients on their diets for various nutrition related medical conditions. I am quickly learning that there is no standard approach for counseling patients in the hospital. Each person comes in with a different story and each education needs to be unique in order to provide the best possible care. 

Here are some tips I’ve picked up in my few short weeks counseling patients in the hospital that have helped me deliver more meaningful diet education:

1.     Formally Introduce yourself: A hospital patient may see many specialists while their in the hospital so it is not always clear to the patient who you are or why you are coming to speak with them. Be sure to be polite, introduce yourself, and make it known what their diagnosis is and how your education can help them.

2.     Assess their level of understanding: Before you dive in and begin talking nutrition science and physiology with the patient figure out what their knowledge level is and how they prefer to learn. Then educate accordingly.

3.     Be a good listener: There is very little time to educate a patient in the hospital setting and I often want to unload all the information I can in 15 short minutes. However, I find asking open-ended questions and actively listening to patients allows me to better assess behavior and knowledge level. Additionally, they may even gain some more insight to their nutrition by talking about their own diet habits.

4.     Create small attainable goals: While it would be ideal for patients to give up all saturated fat, salt, sugar, and fast foods it’s not likely going to happen. People need small measureable goals that they feel confident in reaching. Help create goals that fit into their lifestyle and find strategies to keep them accountable.

5.    Know When to Leave: Despite how important diet education can be for a hospital patient with a diagnosis such as congestive heart failure or diabetes it may not always be the appropriate time. Some patients may be in too much pain, have just learned they have a terminal illness, or may just not be ready to learn about nutrition. It is important to be perceptive of their attitude and situation. A good place to start is just by asking them if it would be ok if you provided them with diet education.

DC VA Medical Center: Clinical Insights

By Nikki Bolduc

This week marks the 8^th, and final, week of my clinical rotation at the DC Veteran’s Medical Center.  Next week I will begin staff relief.   It is hard to believe! 

Based on my own initial perceptions as well as discussions I've had with my fellow internship and undergraduate class, I feel comfortable saying that clinical is by far the most intimidating rotation.  However, I am happy to report that your education does not fail you during your clinical rotation and you will be surprised by the amount of knowledge you can pull from your studies.   

Speaking from my own experience, I have been thoroughly impressed with the amount of attention the dietitians at the DC Veteran’s Medical Center have given me.  The volume of knowledge I have gained each and every day is extremely exciting and satisfying.   To help you gain the most out of your clinical experience, I’d like to provide a few recommendations that have helped me along the way.

Two of my fabulous preceptors.

1. Purchase a small notebook.  Despite how great your memory is you will find plenty of opportunities where you will need to look something up later, jot down a reminder, or add a medication to your running list (another suggestion J). 
2. Purchase a small address book.  Keep a list of medical abbreviations – you won’t believe the amount of abbreviations used by medical professionals and the time it takes to commit them all the memory.   
3. Be the part – arrive on time, dress in proper attire and carry yourself with confidence.  Give your preceptors confidence that they can count on you.
4. Don’t be shy.  You may feel out of place or are just plain uncomfortable in the hospital setting, but remember that most of the doctors, interns, residents, etc. do not know each other either and they are focused on their job (not you). 
5. Be open-minded!  Try to see and do everything you are given the opportunity to see and do.  You will be amazed by what you will learn from each experience and the confidence you will gain from it.
6. Do your research.  Try to be as prepared as possible every day of your rotation.  Your learning is greatly enhanced when you can recall and/or make connections to concepts you have looked over recently.

I hope these few insights are helpful to you.   Good luck!

FNIC: Behind the Scenes

By Wendy Baier

             My partner Melissa and I recently completed our first rotation which was with the Food and Nutrition Information Center (FNIC).  While there, we worked specifically with Team Nutrition whose focus is school meals.  It was a wonderful experience and I was able to learn a lot, not only about nutrition resources but also about all of the behind the scenes work that goes into maintaining a database and website. 

            The Team Nutrition website houses thousands of resources for food services professions.  These range from books on managing staff, to large scale recipes, to pictures and posters to hang in schools.  Pretty much every question you have pertaining to school food service, an answer can be found on this website.  But with all of that information at your fingertips, comes a lot of content management.  This was one of our main projects in the six weeks that we spent in FNIC.  

            Our main goals were pretty simple:

1.      Ensure that all information was still current

2.      Edit descriptions and titles

3.      Seek out the newest resources available

An example of the Access entry form

In order to achieve these goals, we were trained on Access and Drupal.  Access is a database program that houses all of the print resources available on the website.  In Access, we were able to make all of the necessary changes for any given resource.  These changes include adding and editing searchable keywords in order to make the site more user friendly.  When our changes were made, the entire database was uploaded to the site to put our corrections into place. 

The Second tool that we were trained on was Drupal, the program used to make live changes on the website itself.  This was used to manage all of the content that was not housed in Access.  One project that we worked on was the “Features of the Month” section.  In addition to general editing, we added new resources using Drupal.  Immediately after our change, it appeared on the website, allowing for immediate feedback.

An example of a Drupal entry form

Learning both of these tools was incredibly helpful and gave us insight into what really goes on when managing a website.  It showed us how easy it can be to make changes, but also how much time is spent on what originally seemed like a small fix.  Based on this experience, my respect and tolerance for websites has greatly increased.  It has also empowered me to work harder on my website and blog.  After working on such a massive website, my personal web pages seem much less intimidating.