During this rotation, I have been working with 4 other dietitians. Each week I get to shadow/work with a different dietitian, which is really cool because each one has their own floor that makes up a separate disease state/patient condition.
Since this was week 5, I have had the chance to work with every single one of the dietitians and now I am back to the beginning with my main preceptor. She has the 3rd floor, which is mostly the pulmonary patients. This includes a lot of patients with pneumonia, flu, CHF, COPD, etc.
Working with her meant I also got the chance to teach a pulmonary rehab class. If you read back in my last blog post, you’ll see that I got to teach the cardiac rehab patients and I really enjoyed speaking with all of them. This one was around the same amount of people, around 10 to 12, but this time I had to speak on the importance of having good nutrition with the COPD disease state. When you have trouble breathing, it can complicate a lot more issues than you would expect while eating. I didn’t have much experience teaching on this subject so it was a little challenging for the first class I taught. However, the second time rolled around later that afternoon and it went much smoother. Speaking in front of people always gets better with more reps.
During the 6th week, I got to work with a separate dietitian who had the ICU patients. These are patients who usually can’t tolerate eating much at all and typically need tube feedings. This is one competency that I do think I have improved on, which is [CRDN 1.6: Incorporate critical-thinking skills in overall practice.]. I say that I have improved because during the first time around with this dietitian, I had to ask many more questions about the tube feedings and how to go about caring for these types of patients. This time I think I had a much better handle on things. However, I still realize that I do need more clinical knowledge as a whole, and I think this competency is something I could do better on [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.].
Since I need to improve, I wanted to dive a little deeper into the research on a problem we faced in ICU throughout the week. We had a patient who wasn’t tolerating the tube feedings (diarrhea) and we were trying to figure out what the best option was. I decided to look up if there was any difference between intermittent tube feedings and continuous tube feedings. Ciocon et. al found that patients tolerated intermittent tube feedings better than continuous, specifically in terms of diarrhea. I found this super useful and made a note of it for future reference.
Finally, this last week, we also got to participate in Legislative Day in Frankfurt, KY at the Capital. There were multiple speakers on various topics and I think everyone left with a better perspective on Bill 200. It was cool to meet some of the legislators and to tour around the Capital building. My group got to meet up with the Owensboro Representative, DJ Johnson. He said he was on board with Bill 200 and thought it made a lot of sense to make sure the food waste was minimized as much as possible.
From the look of this pic, I think it was a successful trip. :)
1. Continuous Compared With Intermittent Tube Feeding in the Elderly Jerry O. Ciocon, MD, Daisy J. Galindo-Ciocon, PHD, RN, Charlotte Tiessen, RD, Diana Galindo, MD. 1992. Journal of Parenteral and Enteral Nutrition. Vol 16, Issue 6, pp. 525 – 528.