Apart from the occasional emails I’d get about this blog I must admit I largely forgot about it over the last few years. I never took it down because I still get a lot of hits on my post about studying for the RD exam, although I took it so long ago I’m not sure how helpful it still is.
Since working in the clinical area in El Paso, Texas, I had a brief stint in Oklahoma and have lived in Hawaii for the past 3 years. (I LOVE IT HERE SO MUCH.) I enjoyed working as a clinical dietitian before, but it was until I fell into an outpatient position that I truly felt I found my calling.
Initially, I found a job working as a call-in/relief dietitian for a few inpatient facilities on Oahu. It was great – I only worked a few days a week and went hiking and surfing the other days, but it was hard to feel like a true part of the team when you work inconsistently. Then about 2 years ago, there was an opening for the full time RD position at the hospitals outpatient diabetes center that I was going to help fill in for until they hired someone…and I ended up staying there!
Outpatient counseling has been such a rewarding experience. I have grown, professionally, SO much, and have completely fallen in love with diabetes education and all my wonderful patients. (I should write a post on that.) I recently obtained my CDE Certified Diabetes Educator credential. (Also a post for a different day – I remember desperately searching for info on how to study for the CDE exam!)
Personally, I also have become completely obsessed with yoga and went mostly plant-based – poultry, beef, and pork free, gradually reducing fish, eggs, and dairy. (Another post idea…) I live with my amazing husband and our little dog, Ziggy. If you follow me on Twitter you can see how much I love being active outside here in paradise!
Anywho, a couple of my patients commented that they googled my name and read up on my blog, which had become kind of ancient and outdated, so I figured it was worth a little update. Perhaps I will start writing more regularly in 2018…stay tuned!
Entering/reviewing patient notes in the computer
I still can’t believe it’s October. Where has the time gone? I’ve been seeing tons of patients at the hospital. As my sister puts it, “saving the world” except, not. Just trying to optimize people’s dietary intake is all. I’ve seen a lot of cancer patients who need supplemental shakes to boost their caloric/protein intake, and many cardiac patients who need to cut back on their caloric/fat intake. Even when the doctors ignore my recommendations, I know that I’m still making an impact when I am able to spend time with the patients and really work with them. There’s also been a couple quite remarkable cases that I feel I would be violating patient confidentiality if I posted about, but let’s just say it’s been pretty interesting!
Monday was a class day where we learned about FSNE, or Maryland’s Food Supplement Nutrition Education program, commonly referred to as Food Stamp education. We will be doing an in-depth research project for them evaluating their educational curriculums for people who are receiving food supplement aid. We also were able to learn about tips on general nutrition education practices. Food stamps reach a lot of different populations, so you never can predict how a class will go. Several nutrition educators for FSNE were in attendance, so they were able to offer ideas on how to cope with various situations.
Anyway, tomorrow I will be going to the hospital really early to hear a recognized expert on diabetes talk about diabetes and heart disease. It should be interesting to hear about, since so many of my patients have both of those conditions! For now, I must work on my Critical Care homework set. I’ll try to update again later this week!
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.