Getting in the Groove of Things

I begin the second half of my clinical rotation at Frankfort Regional Medical Center filled with confidence and drive.

Not saying that the first half of my rotation went up in flames, but I almost feel reborn, like a phoenix from the ashes. My reservations have burnt away, and I feel much more competent as an entry-level almost-Registered Dietitian.

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To proclaim my confidence is not to say that I am proud or displaying an excessively high opinion of myself. I am humbled by the experience, knowledge, tact and professionalism that surrounds me daily. However, now that I have been around the hospital for a little over a month employees are starting to recognize and remember me. I feel more comfortable approaching nurses and other professionals concerning patients.

My social graces have improved drastically with patients. I have learned to replace "How are you?" with "How are you feeling?" without feeling horribly awkward if it is not always good news. I have practiced empathy with not only patients but also their family members. I have learned to develop rapport with people in subtly different ways from my previous experience in customer service.

I am gaining independence as well now that I am more aware of expectations, which helps me feel accomplished and helpful. Once daily expectations are met I am sure to ask if there is anything else that I could do to help, and I have been complimented by the Director of Nutrition Services for my willingness to be a team player.

Here are some of the highlights from last week:

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In-Service Presentation

The biggest event from last week was my In-Service Presentation with the RNs at FRMC. Although I understand the importance of this assignment, it is also one of the more awkward things I have had to do.

The concept of an in-service is not foreign to me, as I was responsible for multiple in-services as Aquatics Director in my previous place of employment. The difference is that as a director I had years of experience and knowledge of not only my position, but also of those positions leading up to mine. In this scenario, I am essentially an outsider with barely one month of experience working at FRMC, and very boldly labeled as a STUDENT on my ID badge. My credibility is extremely fragile, to say the least.  

This is not to say that Registered Nurses are "mean," but their job is extremely stressful and fast-paced, with long hours varying between first and third shifts. They are very much stretched thin, and have little time to devote to anything other than their patients. Gathering them in a group and holding their attention for an extended period of time is impossible. However, with the right amount of rapport building and confidence, anything is possible, or at least manageable.

My in-service was titled "A Promise for Life," which is the motto for Abbott Nutrition products used by FRMC. It was appropriate because my objective was to get the nurses to agree to prioritizing charting of oral supplement intake, therefore benefiting the Clinical Nutrition department.

I sparked curiosity when I arrived at the nurses' station with a tray full of oral supplements, automatically drawing them in to my presentation. Nurses are rarely ever sitting still, so they came and went interchangeably as I began explaining why I was lurking outside of their station. A few well placed compliments can really help soften a person's perception, and a few nurses hung around to hear what I had to say.

​Long story short, I explained that oral supplements were important to help patients heal and gain strength in order to be discharged from the hospital. We are all working together (MD, RD, RN, social work, case management, respiratory therapists, PT, OT, etc.) to help patients get better, and something as simple as drinking an oral supplement can help tremendously. 

We went over individual supplements and their indications, and I even convinced a couple of the nurses to sample them! ​​I thanked them for being kind and good spirited, and they said they were happy to help!

Tresiba Clinical Overview

Here's a little something out of the ordinary. Last week we went to a pharmaceutical dinner at a restaurant in downtown Frankfort called Serafini's. We were joined by other professionals who work in nearby healthcare facilities, including many from St. Joseph's hospital in Lexington. The medication up for discussion was Tresiba, an ultralong-acting basal insulin analogue developed by Novo Nordisk.

 A sales rep visited FRMC towards the beginning of my internship and educated us about Tresiba. Much of what was discussed at our initial meeting was reiterated over dinner, but I was not expecting to learn so much about the history of diabetes and insulin. Unfortunately the meeting was so intimate that I felt rude writing notes during Dr. Meyer's presentation, but a few things stuck with me.

Before the discovery of insulin, being diagnosed with diabetes was a death sentence. Insulin was first tested on animals, and in 1922 the first human trial was successful. Scientists toyed around with how best to administer the treatment and eventually came up with "units" as a measurement. A unit is the amount of insulin needed to lower blood glucose by X amount (sadly, this is one number that did not stick in my mind.) 

Although insulin is not a cure, it is one of the biggest medical discoveries and has helped to save thousands of lives through the decades. Since it was first discovered there have been multiple different kinds of insulin created, which would take longer than a blog to describe. If you want to know more about the different types of insulin, take a look here. 

Anyways, Tresiba is the coolest new insulin on the market because it is super long-acting and allows patients more freedom in their management of diabetes.

Crohn's Counseling

Whenever there is an interesting patient case on our radar it is always suggested that I take a minute to go talk to them, which is the best way to gain exposure to different nutrition related diseases and conditions. This week I had the opportunity to discuss Crohn's disease with a patient who was diagnosed 15 years ago.

As a future Registered Dietitian, my main focus was uncovering what foods the patient had found to be "trigger" foods throughout the past 15 years. However, people have a tendency to feel uncomfortable when discussing typically private matters, such as their bowel movements. Referring to the GI symptoms typical of Crohn's disease (bloating, gas, diarrhea, cramping) as "flare ups" made the patient a bit more receptive to the conversation.

We talked about foods that could be tolerated and I made it clear that I would relay the information to dietary services. By offering foods the patient can tolerate and enjoy, we are facilitating progress and helping them get discharged sooner. It is also good to let them know that we are available if they ever need anything.

Patient Education Materials

In addition to the rest of this week's highlights was the development of my patient education materials concerning gestational diabetes mellitus and exercise. Our Certified Diabetes Educator counsels many expecting mothers about how to manage their gestational diabetes, which includes physical activity. She had been compiling folders to give to each client, full of information about gestational diabetes and meal planning. However, the handout concerning physical exercise was very outdated, and so I proposed to create a new one for her convenience. She had very specific stipulations, but it was great being able to create something and receive feedback. 

Each experience at FRMC is an opportunity to learn something, and I love the hustle and bustle of the office.

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Competencies:
​CRD 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature (such as the Academy’s Evidence Analysis Library and Evidence-based Nutrition Practice Guidelines, the Cochrane Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Guideline Clearinghouse Web sites) in the nutrition care process and model and other areas of dietetics practice.
CRD 1.4 Evaluate emerging research for application in dietetics practice.
CRD 2.2 Demonstrate professional writing skills in preparing professional communications. (Tip:  Examples include research manuscripts, project proposals, education materials, policies and procedures.)
CRD 2.3 Design, implement and evaluate presentations to a target audience. (Tip:  A quality presentation considers life experiences, cultural diversity and educational background of the target audience.)
CRD 2.4 Use effective education and counseling skills to facilitate behavior change.
CRD 2.8 Apply leadership principles to achieve desired outcomes.
CRD 2.10 Establish collaborative relationships with other health professionals and support personnel to deliver effective nutrition services.
CRD 2.12 Perform self-assessment, develop goals and objectives and prepare a draft portfolio for professional development as defined by the Commission on Dietetic Registration.
CRD 3.2 Demonstrate effective communications skills for clinical and customer services in a variety of formats.
CRD 3.3 Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management.
CRD 3.4 Deliver respectful, science-based answers to consumer questions concerning emerging trends.