Our Lady of Bellefonte Hospital, Medical Nutrition Therapy: Week 1-2

Before the internship started, the rotation that I was most worried about was this one – my medical nutrition therapy rotation.

I was most concerned about this rotation because it is probably my biggest weakness when it comes to my gaps in knowledge and I feel as though the stakes are the highest. My mind went to the worst; I was going to hurt somebody by giving them the wrong tube feeding or I was going to look like an idiot in front of the others because I didn’t understand what certain labs or disease states represented.

After the first two weeks have come to an end, I can happily say that this was not even close to the reality. I have an amazing preceptor and the rest of the dietitians on staff have been more than welcoming. Oh, and I’ve learned a TON already just by paying close attention to how the other dietitians work.

The first activity they put me through was my training on the Epic computer charting system. I didn’t have this training for the first couple days as I was shadowing my preceptor and as she was explaining through the system I thought that I was never going to figure it out. She was puzzling this together with that and this told us this thing so we had to do something else…it was overwhelming. But after I got the training and started sifting through the program myself, the process started to become more and more natural. I’ve now began to chart and make notes on patients all by myself and it is a refreshing feeling. [CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.]

The second activity they put me through was my experience with the Behavioral Unit in the hospital. If you’re unfamiliar with Behavioral Unit’s in hospitals, they are the unit’s that deal with psychiatric patients and emotional and behavioral disorders. To say the least, it is a very different experience than working with patients on a regular hospital floor. You get a wide variety of patients and a wide variety of temperaments. There was an older lady there who was the sweetest little 96 year old I’ve ever met and there was another younger guy there who had a long history of substance abuse. The old lady called me handsome and the younger guy accused me of being a cop and said “I looked familiar.” So, like I said, this was an interesting experience, but fun.

Finally, the last activity and the activity that hit the closest to home with me was my experience in the Intensive Care Unit. If there is one thing that has stood out to me more than anything else during my first two weeks here, it is the perspective I have gained on the preciousness of life. The disease, pain, illness, and hardship that these patients and their families go through rocks me at my very core. It is the main reason why I have avoided the medical nutrition therapy side of dietetics. I can’t stand to see people suffer, but it is a necessary reality for so many of these patients and I’ve had to push out of my comfort zone a little to accept this. It gives me a higher appreciation for the doctors, nurses, dietitians, and everyone else on the supporting staff.

After spending a couple days in the ICU, there was an interesting topic that came up amongst myself and the other dietitians. It was about advanced directives and dementia patients and the ethics behind it. I basically learned about how having dementia can cause a person’s body to reject food. So, there are many cases when patient’s families have to discuss with the doctors about how they wish to proceed because they have to choose to feed the sick patient and cause them harm, or to refuse giving them any more food/liquids by mouth to aid-in-dying. I decided to look up the literature on this subject and found a great study that stated “One option for ensuring that one does not live years in severe dementia is to use advance directives to withhold food and water by mouth. The driving element behind VSED is that forcing people to ingest food is as objectionable an intrusion on bodily integrity, privacy, and liberty as imposing unwanted medical treatment.” (Menzel and Chandler-Cramer, 2014). This just showed me how tricky some situations can be and how important it is to talk with family before something like this could ever occur.

Overall, my first two weeks have been a crash course on how things work in the hospital. How teamwork, knowledge, and empathy for patients can all be combined to save people every single day, one person at a time.


References:

1. Menzel, P. T. and Chandler-Cramer, M. C. (2014), Advance Directives, Dementia, and Withholding Food and Water by Mouth. Hastings Center Report, 44: 23–37. doi:10.1002/hast.313