National Nutrition Month

March is National Nutrition Month and the Food and Nutrition office at Franklin Regional Medical Center is celebrating! This year the theme set by the Academy of Nutrition and Dietetics is "Savor the Flavor," and we have a plan that will help people branch out their taste buds.

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At the beginning of the week I was assigned the mission of re-decorating the cafeteria bulletin board for National Nutrition Month. Believe it or not, this has probably been the most stressful experience of my Medical Nutrition Therapy rotation. Yes, it sounds ridiculous, but I am truly not very crafty, and putting my work on a bulletin board for the entire hospital to view was very intimidating.

I perused Pinterest for ideas related to National Nutrition Month, but everything seemed way too elementary for healthcare professionals. One of the dietitians in our office thought it would be a good idea to consult Sodexo's website for their recommendations. Sodexo is the food service and facilities management corporation that oversees operations for FRMC's cafeteria, and you have to have an employee account to access their materials. Sodexo's idea was to highlight a different country during each week of National Nutrition Month, with the theme "Experience a World of Healthy Flavors," which aligns nicely with the Academy's theme. So we went for it!

​​Although it appears as if this bulletin board took just a few minutes to assemble, it actually required an entire work day. First, I had to access Sodexo's website using my preceptor's login information and download the files for each country we wanted to highlight.

After sifting through the files (and finding ones that open) I managed to print what we needed on card stock. I also had to visit four different stores in order to find materials for the bulletin board, which was quite the adventure.

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We chose to highlight Africa, Bavaria, Grenada, and Thailand throughout the upcoming weeks. The most fun part about this task was searching for a recipe to include with our theme. Unfortunately, our kitchen was unable to participate by coordinating Sodexo's suggested theme recipes, but we decided that offering a recipe from each country was just as well.

We plan to hand out crossword puzzles related to each country and use them as a drawing for prizes. The prizes have yet to be determined, but perhaps it will be a basket of herbs and spices to inspire the winners to "Savor the Flavor!" 

Counseling and Education

This week lent ample opportunity for nutrition counseling and education, which I attribute in part to our daily meal rounds. As of late, my preceptor has been giving me more independence, allowing me to do the meal rounds all on my own while she works on other projects. Not that I don't enjoy her feedback when we do them together, but I get a sense of satisfaction and accomplishment when I am able to do things on my own and allow her time to work on administrative tasks.

During meal rounds I get a chance to connect with the patient and sometimes their family members. I have found that many people request information during this time, which is always fantastic for a few different reasons. One of the main reasons being it is easiest and most rewarding to teach someone who is self motivated to learn, versus someone who is ordered by a physician to receive education. Attitude and overall disposition is much more positive from those who independently seek advice from us rather than from someone who is solicited into our services.

Counseling

​My favorite patient experience this week was visiting with an elderly woman in her room to discuss her eating habits. Her meal and fluid intakes were poor in the medical chart, so I made a point to stop to talk to her and see what we could do to help. As it turns out she was having a hard time chewing the foods we were sending to her. She reported no troubles swallowing (Speech evaluation confirmed this the next day), but was simply getting tired while trying to chew and would fall asleep before finishing a meal. She also claimed to be lactose intolerant and was not interested in oral supplements.

This was a very productive conversation and we ended up changing her diet to mechanical soft, so that she would not have to go through the trouble of cutting her foods or trying to chew them. Her daughter reported a big improvement the next day at meal rounds. 

Education

There were two different opportunities for education this week, one of which was requested by the patient and the second of which was referred to us by the Wound, Ostomy & Continence Nurse.

During meal rounds one day I came upon a patient who was diagnosed with acute pancreatitis. As soon as I introduced myself she all but sprung up out of her bed with excitement and was full of questions. She had apparently been admitted for pancreatitis, sent home, and then readmitted a day later for the same symptoms. Luckily I was familiar with pancreatitis for the initial round of questioning, but I recommended printing out a packet of dietary recommendations specific to pancreatitis to prevent re-admittance.

She was very open minded about the recommended dietary changes of eating smaller, more frequent meals. However, she was disappointed when I recommended the low-fat dietary changes, as she was a big fan of steak and potatoes. Using the food groups listed in the education packet, we made a few goals based on what she felt comfortable changing immediately, including low-fat crackers and 1% milk, which required a bit of negotiation. We also discussed the importance of progressing slowly after discharge, advancing her diet one food at a time and being mindful of the affects on her digestive tract.

The second patient education was not as successful, unfortunately. The patient had an ileostomy placed during admission, which you can read about here, and was not adjusting well. He was adjusting well to the procedure, but was feeling very uncomfortable about discussing it with others.

The Wound, Ostomy & Continence Nurse consulted us for providing dietary recommendations before discharge, and warned us that the patient was not receptive to education. Once again, I printed supplemental materials for the patient to take home with him. 

I literally entered the room right after the nurse told the patient he was being discharged, which only exacerbated his unresponsiveness to education. He would not make eye contact or turn towards me as I spoke, despite my attempts to connect with him. Finally, after briefly discussing the effects of different foods on ostomy output and the importance of electrolytes, I handed him the packet and told him it was a great tool for him to consult once he returned home.

Techniques

Education opportunities are a great means for practicing nutrition counseling skills, including active listening, body language, open-ended questions, paraphrasing, and summarizing. In situations where the client is open and receptive, such as with the pancreatitis patient, motivational interviewing can even be effective.

It is much less intimidating to practice these skills in a one-on-one scenario than it is in a classroom full of people or in front of others. After these types of interactions I always like to take a moment to quickly reflect on what I did well or what could have been better. I typically analyze and process the patient's reactions better retrospectively and can identify where my delivery was weak.

​It is a goal of mine to be able to use counseling skills to generate change in people.  

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Competencies: 
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 2.5 Demonstrate active participation, teamwork and contributions in group settings.
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 2.13 Demonstrate negotiation skills.
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.