Before
I began my clinical rotation, I had this idea in my head that you couldn’t
connect with patients in the hospital: either they’re too sick to talk to or
they’re discharged before you have a chance to make an impact. I had never seen
a dietitian in action in an in-patient setting before so I had no clue what to expect. But as someone who likes to form relationships and bond with
people, I had assumed that being a clinical RD was not for me.
During
my first week at Harbor Hospital, I quickly learned how wrong I was. Yes,
sometimes the patient leaves before we have a chance to see them and yes, some
people are not very receptive to what you have to say but for many patients and
family members, speaking with a dietitian can make a huge difference. Some
people have received mixed messages in the past or never received a diet
education before—and they are really grateful that you stopped by.
I
realized that knowing kcal/protein needs in different disease states, nutrition
support calculations, and how to provide diet educations are not the only
skills a clinical dietitian needs. They also need to have empathy, or the
ability to understand the feelings of another person. Here are some phrases I found myself saying
over and over to patients, and it really helped them feel at ease:
“What are your
concerns about making healthier choices after you leave?” It’s easy to blame
the patient for their poor decisions or to become frustrated when you’ve seen
someone several times in a month for the same admitting diagnosis. But we have
no clue what that person has been through, and although nutrition is our top
priority, it may not be theirs. Maybe the person can’t control their diabetes
because they are homeless without consistent access to food, let alone healthy,
carb-consistent meals. Maybe the person needs to deal with their alcohol or
drug dependencies before their diet becomes a priority. It is crucial to learn
more about the patient as a whole, and not just the signs and symptoms brought
them in.
“Tell me more about
it”.
Or something along those lines. This can be difficult because you may have
patients who aren’t very forthcoming. It may be their personality, it may be
that they are overwhelmed with everything that’s happening to them, or it may
be that they are afraid of being judged. Be patient—if no one has asked them
food- and nutrition-related questions before, they will need some time to
reflect. Tell them that you’re there to support them and to discuss their needs,
not just to tell them what they should/shouldn’t eat.
“That reminds me of a
time when…so I realize how frustrating that is”. It’s totally okay to share your experiences
with patients. Being relatable will put them at ease and hopefully encourage
them to open up to you. It may be helpful
for them to hear that dietitians are human beings too—we struggle with weight
loss, being short on time, limited budgets, enjoying junk foods, etc. just like
everyone else. But remember to maintain
a professional relationship! Only share relevant stories and make sure you
don’t reveal any private information.
“Would you like me to
come back later?”
For some people, the hospital setting is shocking and depressing. They have had
a lot of time to come to terms with their health problems and what led them
there. I’ve had some patients who cried during my visits—some wanted me to
stay, some asked me to come back later. Let them be open with you if they want
to share. Sometimes they will answer your questions so they can rest and not
have you return. If they aren’t willing to talk to you, take a hint and leave.
“I’ll stop by later/tomorrow to see how
you’re doing, if that’s okay with you”. Each
hospital will have follow-up protocols depending on the risk level of the
patient. But if your schedule allows it,
you can try to visit patients that are having a particularly hard time or are
not eating well more often. Or follow up with patients who received a diet
education since they may need time to read over handouts and could come up with
questions after you leave. People appreciate you checking in on them and enjoy
seeing a familiar face.
Even
though the time you have with a patient is limited, being empathetic can show
that you care about their wellbeing, making a big difference during a difficult
period in their life. My rotation at Harbor Hospital was very rewarding and taught
me two important things: it’s definitely possible to bond with patients in an
in-patient setting, and I would actually love to be a clinical RD!
