Winding Down...

Yet another week of experience is in the books. Medical Nutrition Therapy at FRMC is winding down, and I am realizing there is little time left for cramming as much knowledge into my brain as possible before moving on down the road.

---

This past week was chaotic on a multitude of levels. On top of our typical case load of patients were back-to-back meetings, my massive case study assignment, our site visit with the Dietetic Internship Director, and administrative struggles related to tuition. It was an emotional roller-coaster to say the least.

The site visit went really well, in my opinion, and it was nice to share a slice of my life with our internship director. We talked for almost an hour about the different experiences I have been exposed to throughout the last 2 months. It was also perfect timing to have a visit, as I was feeling the stress of the case study assignment. It was nice to have moral support at that time.

For the most part, this week was pretty ordinary, but there were a few noteworthy highlights.

---

Frankfort Senior Activity Center

Last week we took a post-lunch stroll across the way to the Senior Citizen's Center. Our dietitians at FRMC will be participating in a Healthy Food Expo at the center next week, alongside various other health-minded businesses from the Commonwealth. Unfortunately, I will be participating in KAND and will not have the opportunity to attend this health fair.

The Senior Citizen's Center is a fantastic community for, you guessed it, seniors. Anyone who is at least 50 years of age and older can sign up to be a member, and it only requires your signature on a form. The center organizes a variety of activities for its members including line dancing, yoga, bridge, live music, Friday Flicks, day-trips, and weekend excursions. They even organize "Mystery Tours," where you can get on a bus headed anywhere, only to find out the activity once you arrive. Anyone in the community can participate in most of the events they host, and not everyone who attends is of senior status.

Our lead dietitian at FRMC is closely involved with the center by helping to organize their quarterly cafe menus. The Senior Citizen's Center offers a hot meal daily at an affordable price, but they are regulated by very strict guidelines. Our dietitian helps their administration follow these guidelines while also keeping the menu fresh and interesting. Also, a lot of the senior citizens who frequent the center are also regulars in our cafeteria at the hospital. We know many of them by name, and I look forward to catching up with them each afternoon.

Patient Counseling

Another week brings another education opportunity. We had a patient this week who had a Roux-en-Y gastric bypass surgery about a decade ago, who has suffered from severe nausea and vomiting since the procedure. After the surgery the patient lost almost three hundred pounds, and dropped well below ideal body weight.

Throughout the last five years the patient has suffered from severe malnutrition secondary to altered GI function. In addition to the difficulties surrounding eating are the patient's specific food preferences. I worked very closely with this patient to help figure out how to help her meet her nutritional needs. Speaking with her during meal rounds every other day was very educational, and I learned that her family was bringing food that she prefers, including a nutrition supplement powder. 

It feels really good to feel like I'm being helpful to patients. Not everyone wants your help, but when they do, it is a fantastic feeling. My communication skills have grown exponentially throughout my time at FRMC.

Mead Johnson Nutrition

The main event of last week, as far as my preferences are concerned, was the healthcare professional education meeting we attended at Tony's of Lexington. Dr. Dawn Forbes from Kosair Children's Hospital presented her research concerning the "Multi-modal Program to Decrease Length of Stay & Additional Opiate Exposure by up to 80% in Infants with Opiate Exposed NAS."

Dr. Forbes has been studying the treatment of NAS babies at three different hospitals in Kentucky for the past five years, all of which operate different levels of NICUs. Interestingly enough, the Level II NICU was actually at FRMC, which I was completely unaware of prior to this lecture. Essentially, Dr. Forbes experimented with a combination of methods that could help reduce the length of hospital stay for babies born exposed to opiates.

For the sake of time, and without boring you with all the nitty gritty details, we'll cut to the chase and say her results are really amazing. Out of all three hospitals they found the most success at FRMC, the Level II NICU, which she attributes to great nursing staff who are willing to learn new procedures. At the larger hospitals there were typically protocols for handling NAS babies already in place, and resistance to change impeded results.

Throughout the course of five years of research, Dr. Forbes managed to reduce the length of hospital stay for NAS infants by 72%. Multi-modal treatment also managed to reduce the length of treatment for infants with exposure to opiates by 80%. Wow!! Most interesting to me was the impact her treatment had on breastfeeding rates for this population of mothers. In the beginning, less than 6% even considered trying to breastfeed. Now, 56% not only initiate breastfeeding, but also continue to breastfeed for an extended period of time. 

I was honestly completely blown away by the success of her treatment plan. In addition to pharmacological treatment, her ability to provide a nurturing environment for mothers, fathers and their babies has significantly improved the family unit in this population. It is truly remarkable.

Dr. Forbes was an outstanding speaker. I would sit through the same lecture again.

---

Competencies:
​CRD 1.1 Select indicators of program quality and/or customer service and measure achievement of objectives. (Tip:  Outcomes may include clinical, programmatic, quality, productivity, economic or other outcomes in wellness, management, sports, clinical settings, etc.)
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 1.3 Justify programs, products, services and care using appropriate evidence or data.
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 2.4 Use effective education and counseling skills to facilitate behavior change.
CRD 2.5 Demonstrate active participation, teamwork and contributions in group settings.
CRD 2.7 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice.
CRD 2.9 Participate in professional and community organizations.
CRD 2.10 Establish collaborative relationships with other health professionals and support personnel to deliver effective nutrition services.
CRD 2.11 Demonstrate professional attributes within various organizational cultures.
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 3.1 Perform the Nutrition Care Process (a through e below) and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.
CRD 3.2 Demonstrate effective communications skills for clinical and customer services in a variety of formats.
CRD 3.4 Deliver respectful, science-based answers to consumer questions concerning emerging trends.