Basic template- I still have a lot of work to do!
Today we had technology training at the National Agriculture Library in Beltsville, MD. We learned about copyright issues with online images, databases, making surveys and polls, and we also got time to work on our websites. Creating surveys was pretty cool- we explored a few different ways like Survey Monkey, Survey Share, Polldaddy, and Googledocs. I practiced making my own survey on Googledocs- you can check it out, but I won’t be needing any data so you don’t have to fill it out! I also made a lot of progress on my website, since I’ve been so busy with clinical I haven’t had much time. We learned more about photo editing and embedding, and I finally figured out how to make a template (although it’s quite possibly the simplest template ever!) I’ll post the link once it looks presentable…which it probably won’t be for a while haha.
Back to the hospital tomorrow morning!
Well, this upcoming week is the 5th week of my clinical rotation. I have to do 8 weeks at my current hospital, 2 more weeks at a different hospital (just to get another perspective from how another place runs things), and then come back to do 2 weeks of staff relief at my original hospital. 12 weeks total clinical, technically. It’s a long time, but I don’t mind- I am really enjoying what I’m doing just because it’s so interesting!
Because the 8-week period is halfway over, I had an evaluation with my preceptor. He said I’m doing very well so far, which was great to hear! He even observed me while I educated a patient on dietary interactions with the drug Coumadin. (Coumadin prevents blood clots by thinning the blood, and you have to watch Vitamin K intake because K promotes blood clotting mechanisms.) One thing I do need to work on is my “authority”- aka my confidence and portraying myself as an expert (although I don’t feel like one just yet!) I’m sure that will come as time goes on, however, as I become more and more comfortable.
Friday was an exciting day. I finished up my mini case study report on a patient I had been following for a few days. He had not only diabetes…but hypertension…congestive heart failure…and worsening chronic kidney disease! He was definitely more complex that originally anticipated, but I got to learn a lot about how all these conditions affect each other. Plus he was the nicest guy who was great to work with.
Friday I also did FOUR patients, which is the most I’ve ever done. I followed up with my case study, did a diabetes and low-sodium diet education, assessed a patient with severe nausea/vomiting from chemotherapy, and worked with a patient to find soft foods he could eat since he didn’t have a lot of teeth.
This week’s homework topic is enteral and parenteral feeding, which is nutrition support in the form of tube feeding and IV administration. Speaking of homework…I have to get back to doing it! I’ll try to update again later this week, hopefully after getting the chance to write some nutrition support orders!
…which I really am!
This surprises me because I didn’t think I would like clinical. I’ve always enjoyed the public health aspect of dietetics, such as outreach and nutrition education. Hospitals have always kind of stressed me out, to be honest. And it’s really hard to see patients that are truly suffering…and then ask them about something as seemingly trivial as “can you tell me about your typical diet?” (Although we all know diet can help with the management of chronic disease, of course.)
However, interning at the hospital has been very exciting. I’m never bored or sitting around staring at the clock so I can leave. I’m either going through doctor and nurse notes, visiting with patients, shadowing dietitians, or writing diagnoses and interventions. When I leave my house in the morning, I’m actually thinking, “I wonder what I’ll come across today” and it’s true- with each day comes a new experience. There’s no “typical” day thus far, nor a “typical” patient. I’ve gotten the entire range of personalities, from the non-compliant people who don’t want to hear what I have to say whatsoever, to one patient actually requesting for me to come back the next day!
Hopefully I’ll still think this way in a few weeks when my patient load gets higher and more complex…!
It’s nearing the end of the second week and I’m learning so much! Yesterday I performed a diet history with a diabetes patient, and today I did two more. We do this to measure how much they adhere to their prescribed diabetic diet and monitor their blood sugars, use insulin, etc. Using that information, we are better able to make a recommendation on how to improve their health outcome. I was a little nervous at first, but I’m gradually getting a little more comfortable with interviewing patients.
Today I was also able to write two patient notes and enter them into the complex computer system that the hospital has. Unlike where I used to volunteer, this hospital doesn’t write standard notes; they enter data into a sort of database that generates a note for them! It’s extremely efficient if you know what you are doing…which is what I’m working on for now! It takes a while to get used to, but I’m sort of getting the hang of it. Practice makes perfect, right?
There are many parts to a nutrition note: assessment, diagnosis, intervention, and monitoring/evaluation. My job is to scour the doctors’ and nurses’ notes for relevant information such as height, weight, general appearance, diagnosis, past medical history, and medications. Then, I go and speak to the patients about their habits. Next, I make a nutrition diagnosis using the American Dietetic Association standardized language, which for now I have to look up in a book until I become more familiar with it. It goes: “(problem) related to (etiology) as evidenced by (signs/symptoms).” Then I decide what intervention needs to be done, such as their caloric and protein needs, and which kind of hospital diet they should be assigned. Last, I set goals and describe how to monitor them.
It took my whole day to do two patients; by the end of the rotation I’ll be able to do 5-6 complex patients per day! Although we’ve been focusing a lot on diabetes, soon we’ll change the focus to oncology, then to cardiology.
I have jumped headfirst into the internship with the seemingly busiest, most demanding rotation first: clinical. In this internship, we have a partner that we do rotations with. However, the clinical portion is individual, so it’s a bit intimidating!
I am so grateful that I had a lot of volunteer experience at George Washington University Hospital in DC. I remember how terrifying it was to just walk into a patient’s room and speak to them at first! I was fortunate enough to be able to shadow some of the dietitians there as well, which has made the start of clinical just a tad easier. At least it’s not all brand new!
So far, I have become oriented to the hospital and shadowed my preceptor doing the normal tasks of a clinical dietitian such as writing tube feedings, visiting with a couple patients, and working with the nurses and other hospital staff. Next week, I will become more involved in the daily duties of a dietitian. I also have homework to work on, both for clinical assignments and to begin building my electronic portfolio!
For now, I will enjoy the long weekend 🙂 Happy Labor Day!