LEARNING THROUGH TEAMWORK

By Megan McClelland

Have you ever heard the saying, “teamwork makes the dream work”? During my interprofessional education (IPE) training I experienced this first-hand. As I worked alongside students of other healthcare professions, my eyes opened to the importance of collaboration between nurses, pharmacists, social workers, and dietitians. It was a wonderful opportunity for each student to share their specialized knowledge.

Patient centered care

What exactly is IPE?

Interprofessional education, or IPE, is when students from different health and social professions work together as a part of their professional training. The goal of this method of learning is to develop collaborative practice so that students provide the best patient-centered care.

IPE training 

So, how does this group learning work? For my IPE, I first had to attend a training session. Nursing, pharmacy, social work, and nutrition students all gathered for a day to learn just how this process works. The training started with each student pairing up with another of a different discipline. I paired up with a second-year nursing student.  We asked each other a series of questions to learn about our educational background. I learned that her program was 3 years long and required both classwork and intense hands-on practice. Next, the entire group came together and shared what each pair had learned about nursing, nutrition, pharmacy, or social work. I thought I knew a decent amount about each profession, but as I listened I was surprised how much I still had to learn! It was fascinating to hear about the academic requirements and years of training that are required to become a licensed health professional. 

What does IPE look like in practice? 

IPE showed me the benefit of collaborating with other health professionals. By working together, we were able to provide the best care for patients. My IPE experience occurred once a week for three weeks at health clinics in Germantown and Gathersburg, Maryland. The goal of the clinics were to help each patient better control their diabetes. Because the patient population was mostly spanish speaking, we used a phone interpreter to communicate. This took some getting used to. When using an interpreter, you speak to the patient in English, then the interpreter translates it into Spanish for the patient to understand. The patient responds in Spanish, which the interpreter translates back to you. As you can imagine, this process takes time and patience. 

Each week a team consisting of a student from each discipline, nursing, pharmacy, social work, and nutrition, would visit a patient. We each took turns asking the patient questions to learn what brought them there and what we could do to help. The first day I was pretty nervous. I had never worked with students of other health professions before or used a phone interpreter to speak with a patient. So, when I entered the room of our first patient, you can imagine my relief when the patient had a big welcoming smile on his face. My nerves calmed a little. 

Our team decided that our nursing student would be the first to speak. Using the interpreter, she welcomed the patient and explained that this appointment would be a bit different than any other. As the patient shared about himself and the difficulties he had with managing his diabetes, I took notes. After the nursing student finished her questions, the pharmacy student asked about the patient’s medication regimen and the social worker gained insight on his home life. This information was extremely helpful as I brainstormed what questions I needed to ask and what nutrition education he would benefit from. Finally, it was my turn to talk about my favorite topic – food! First, I asked the patient what he typically ate. Then, I asked if he had any questions. I learned during IPE training that if you speak in long sentences, the interpreter has difficulty getting every point across to the patient. So, while speaking with the patient, I intentionally spoke in shorter sentences, making sure that the interpreter could translate my words accurately. After learning about the patient’s lifestyle and way of eating,  I offered insight on how he could make small changes to better manage his diabetes. He was very thankful for my recommendations and determined to make a change.

The nutrition students

The IPE experience showed me the importance of collaborative practice, provided experience communicating with patients of a different language, and gave me confidence in my patient care. I not only gained more insight about the patients, but also was able to use this information to provide more valuable nutrition recommendations tailored to the individual’s lifestyle, culture, and socioeconomic status. Nutrition and health care is not one size fits all. A recommendation for one person may not be useful for another, which is why it is so important to get to know the patient. As I become a registered dietitian, I will remember the importance of working together with other health and social professionals to provide the best individualized care.

Bringing Healthy Food to Schools Through Competition

By: David Cover

When you think back about your childhood, what do you remember most about the food served in the school cafeteria? For me personally, I remember lots of greasy pizza, french fries, and sloppy joes. I am not sure if I ever ate fresh fruit or vegetables. Over the years I have heard about how schools have been trying to implement healthy meals including fresh fruits and vegetables. I always believed that most children would prefer greasy, fried foods over fresh, plant based options if they had a choice. I know that my 10 year old self would choose the french fries over broccoli any day of the week. However, after my rotation with Montgomery County Public Schools (MCPS), my beliefs on this subject radically changed.

The dietitians at MCPS have been working tirelessly to offer a variety of fresh fruits, vegetables, and low sodium meals at a very low cost to children and their families. The staff at MCPS understand that many children may be reluctant to try foods such as whole grains, soy based products, green vegetables, etc, so they have devised clever ways of introducing these important foods into the menu. For example, all of the pizzas served now use 100% whole grain crust, and they have somehow been able to produce vegetable chicken nuggets that taste like the real thing! Believe it or not, the children are actually enjoying these healthy food options. I couldn’t believe my eyes when I saw students choose the chicken salad over a steak and cheese sandwich. During this rotation I learned that dietitians have a two fold goal for introducing these healthy ingredients. Successfully introducing these healthier menu items is not only important for children’s health in the here and now; over time children will become more accustomed to the flavors of these healthy ingredients, making them more likely to eat well later in life.The dietitians and chefs at MCPS have really done a great job at providing healthy, nutritious meals that satisfy the students’ tastes, all for a very low price.

In addition to providing nutritious and tasty meals for the students of Montgomery County, MCPS has even encouraged children countywide to come up with their own healthy recipes. MCPS has partnered with Real Food for Kids (RFFK), whose mission is to promote nutrition and health literacy to children of all ages. Just this year RFFK held a culinary challenge for more than 100 students from five local school districts with the goal of creating a nutritious dish that would be featured on the school lunch menu next year in Fairfax, Prince William, Arlington, Loudoun, and Montgomery County schools. Takoma Park Middle School students won this challenge with their “Kale Power Bowl.” During my rotation at MCPS, my internship partner and I were able to assist in preparing this recipe in our test kitchen to ensure a smooth rollout in the schools.

This “Power Bowl” consisted of kale, roasted squash, shredded chicken, quinoa, apple slices, raisins, and a chipotle salad dressing. It was hard to believe that middle school students came up with this recipe; I don’t think I have ever made a salad that fancy! It was a great experience working with a chef at MCPS to determine the best way to instruct kitchens to prepare the salad. I was able to learn about the various restraints large food service organizations have to work within in order to roll out recipes to large populations. The MCPS cafeteria staff gets extremely busy preparing meals throughout the day so it was important for us to determine the most efficient way to prepare the salad in order for it to be easily prepared at all the schools countywide.

In the end, we had to use a rice/quinoa blend to cut costs and craisins because MCPS already places large orders for craisins and had them on hand. I also learned that if we blanched the kale instead of serving it raw, it would take away some of the bitterness and make it look more appealing to the students by brightening the color. Hopefully our modifications worked to both increase student interest in the salad and make it easier for the kitchen staff to prepare. Other school districts might have to modify the recipe in other ways, but our recipe turned out great and I look forward to hearing students’ reactions in the coming school year.

It was a great experience interning at MCPS division of food services, the staff there really cares about school nutrition and work very hard to ensure students are receiving great tasting and nutritious meals at a reasonable price. Public school nutrition was an area of food service management that I really enjoyed, and I hope to have the opportunity to work in this area again. Until then, I look forward to preparing this “Power Bowl” at home for myself to enjoy.

Roles in Recovery – A day in the life of a dietitian working with eating disorders

By: Caty Saffarinia

Food, body image, obsession, control, dieting, and weight are all factors that have become very prominent in society. Who wore it best? What is the best diet to follow to lose weight? How can I look like a supermodel? Media has created a “thin” culture by advertising fad diets, telling people what diets to follow to lose weight in a short period of time, and by showing off celebrity’s body types and looks. These all contribute to people having poor body images and developing a bad relationship with food. Dietitians are an important part of the healthcare team caring for those with eating disorders and I was thrilled to get experience in this field. I am already familiar with Center for Discovery (CFD), since I previously worked there as a diet technician and counselor.  CFD is a residential facility for adolescents, ages 10-19, who struggle with eating disorders.

Food is essential to sustain life, but those who struggle with eating disorders have a different relationship with food – to the point of obsession. For some, food causes disordered eating that includes rituals, avoidance, discretion, fear, and many other emotions and behaviors for people struggling with eating disorders.

Why I want to work with adolescents with eating disorders

Throughout my teen years some of my peers experimented with restricting, binging, and purging as a way of building self-confidence and control over their own looks and beauty.  Watching them suffer from these diet trends, made me want to learn more and combat “negative” talk about food.

My interests were further deepened by experiences with a friend struggling with anorexia nervosa. She felt that the only way to control her life was by the food she consumed, which eventually turned into an unhealthy obsession. Over the years she became emaciated as her self-confidence began to dwindle.  She was plagued by her obsessive thoughts and behaviors surrounding food and body image.  Unfortunately, after several years she lost her battle.  This loss helped me realize the importance of nutrition. Helping individuals with eating disorders became my passion.  My goal was to help transform these devastating situations into powerful success stories. I became more motivated than ever to help those struggling with fear of food and poor body image to gain a sense of control in a healthy manner.

From diet tech to dietetic intern

The nutrition program at CFD instructs that all foods fit in balance, variety and moderation. I really like this belief because it shows clients that there are no “bad” foods. Incorporating this into their treatment is essential for their recovery. I kept this in mind during my internship rotation at CFD. As I worked with my preceptor and the clients, I learned how to utilize nutrition counseling when meeting with clients in individual sessions and how to get clients to talk about foods they fear the most and what they are willing to do for their recovery. When I worked at CFD as a diet technician, I learned about the importance of connecting with patients through empathy, honesty, and patience to create a safe place for recovery. I practiced creating a level of trust with clients to break down barriers in the way of their recovery. I used this skill by meeting the client where they were at with their recovery and focused on achievable goals. Building trust with clients benefited me during my internship because it allowed me to connect with clients and made it easier for them to share their emotions and challenges with me and my preceptor.

My Preceptor, Maureen, and me holding the All Foods Fit model

I was able to use the knowledge I gained from my education and work experience to help me navigate my way through my dietetic internship, specifically my clinical rotation. I have also had the amazing opportunity to work in a hospital with great dietitians as preceptors for my clinical rotation, where I learned so much more about diagnosing patients with malnutrition and following lab trends to assess for refeeding syndrome. For my second clinical rotation, I got to go back to CFD and shadow two dietitians that I formally worked with when I was a diet technician. It was like going home…to where my passion began to flourish.

It was wonderful to see all of my old coworkers and to actually be a part of the treatment team and see the role the dietitians have in the treatment of adolescents with eating disorders. When a new client arrives, the dietitian meets with them to gather a diet history and full nutrition assessment. They also get a 24-hour food recall from the clients to give them a better idea of how much they were consuming prior to arrival. Based on this information and their growth chart, the dietitian is able to calculate required energy, protein, and fluid needs, as well as determine if the client needs weight gain, weight loss, or weight maintenance. CFD uses the diabetic exchange system for all clients. The dietitian uses the required needs to provide the client with the appropriate amount of exchanges to allot and plan for during meal planning. As a part of treatment, each client’s family comes to the site midway through treatment. They meet with the dietitian and therapist together, without the client present, to discuss the client’s progression and so that the dietitian can provide the family with an explanation of how the exchange system works. After meeting, the client joins the family and they share a meal together. During this meal the family is responsible for checking the client’s food measurements for accuracy. The client describes the “table rules” to their family, which include: no food talk, no shoes, hands on the table, no fidgeting, no micro-biting, and completing the meal within the allotted 30 minutes. Following the meal, the clients share “triggers” that might affect their recovery as well as any concern they have about completion of treatment. The dietitians have individual sessions with clients, where they discuss how the client is doing with meal/snack completion as well as developing goals relating to food and nutrition as part of their recovery. The dietitians offer clients support and work with them on trying a “fear” food as part of an exposure therapy. Throughout treatment, the client’s weight and food compliance are assessed by the dietitian. CFD has a treatment team meeting, where the dietitians, therapists, doctor, psychiatrist, facility manager, and program director all meet once a week, to discuss the progression or regression of each client and if they are eligible to “phase up,” meaning the client has shown improvement, both physically and mentally, and is following their treatment plan with the intention to recover.  Based on this, the client is then considered for discharge from residential and referred to an outpatient team.

I was only able to shadow at CFD for a few days and didn’t have enough time to see everything. Two other important things that the CFD dietitians do is to run weekly nutrition and kitchen skills groups. The dietitians run a nutrition group to provide all clients with additional nutrition education relating to the mind, body, and proper health. They also run a weekly kitchen skills group where the residents pick a sweet or savory food to make together and then they eat it as part of their exposure therapy to fear foods. This helps them reintroduce these foods back into their life.

The dietitians at CFD utilize the mindfulness and intuitive eating principles, in addition to nutrition counseling. Mindful eating teaches the clients to get in touch with their satiety cues by using their five senses and staying aware/present while eating. With intuitive eating clients must learn to focus on their individual recovery, as well as reject the diet restriction mentality, make peace with food, honor feelings without using food, honor health, and respect your body.

Working with adolescents with eating disorders as a dietetic intern reaffirmed my goal to make a difference helping those struggling with eating disorders to recover and gain a healthy relationship with food, mind and body.

The Role of Graphic Design in Dietetics

By: Alexis Mateer

Me with my poster on sustainable farming practices

Do you want to be an entrepreneur in the nutrition field? Do you ever want to own your own business, go into private practice, or even just develop more visually appealing education materials for your patients? If so then you need graphic design in your life! Graphic design is necessary for marketing purposes in a variety of fields. Within nutrition and dietetics, it’s necessary for disseminating nutrition information through creation of images that, for example, demonstrate serving sizes or nutrition facts. Now I am no graphic design expert; I am simply a dietetic intern who, through her internship, has discovered the benefits of embracing graphic design!

I got matched to University of Maryland (UMD) College Park Dietetic Internship, and I can confidently say that I am glad I did. I knew from the beginning that the internship has a technology focus; I just did not realize that the tech focus encompasses elements of graphic design.

How I got my Feet Wet with Graphic Design

My third rotation of this internship was in UMD’s campus dining services department. My intern partner, Abby, and I walked in on the first day and were welcomed with a packet of projects. The site has had interns before, so they were well prepared for us and knew how they wanted to use us. The rotation was three weeks, and it was demanding. Essentially, we were tasked with marketing the Cool Foods Movement to the student body, as well as creating educational nutrition infographics. The Cool Foods Movement is about elevating sustainable practices to help reduce greenhouse gas emissions. UMD was the first university to sign the Cool Foods Pledge—reducing food-related greenhouse gas emissions by 25% by 2030. Both marketing the Cool Foods Movement and creating nutrition infographics required that we design visual educational materials. 

Table Tents, Articles, Posters Oh My!

Abby and I were each tasked with making 3 table tents, one poster, and two nutrition article fact sheets. We had three weeks. They all had to be on the Cool Foods theme. For all of our graphics we used Canva. Canva is a website that allows users to easily make infographics, flyers, posters, magazine covers, etc. Throughout this rotation I got better and better at using Canva to create what I wanted. At the end of the rotation, our preceptor told us that our graphics were some of the best she had seen! I’d never before thought of myself as being very tech savvy or a design natural, so I was pretty proud.

Wellness Walls

Wellness Wall week one

Each week of the internship Abby and I also created a Wellness Wall. This is a bulletin board that contains one nutrition tip, cooking tip, healthy recipe, and exercise tip. The bulletin boards and infographics needed to have a united theme. The theme Abby and I chose was, “It’s Spooky Season, but Healthy Habits don’t have to be Scary.” We also had to replicate each bulletin board in Spanish. 

Why I think Graphic Design is Relevant for Dietitians

So why is this important for dietitians, or future Registered Dietitians (RDs) like me?

  1. Health Literacy

It’s simple: images can be easier to understand than words. For some, language and literacy are barriers to healthcare and medical advice. Abby and I came to this realization when creating an infographic for UMD’s dish room staff. The infographic used both words and images to detail the safe use of the chemical Scale Away. Since the diverse staff included individuals that speak different languages, we realized that making a highly visual graphic utilizing common safety symbols was best.

  1. Different Styles of Learning 

Not all people learn the same ways. Personally, I learn best by seeing and then doing. Not everyone is going to be able to read a document or educational material and understand it or be able to act on it. We can’t expect clients or patients to be able to do the same with nutrition advice. Having the ability to give patients verbal, written, and visual instruction or education will enhance their comprehension and create lasting, powerful messages. Infographics are powerful tools that incorporate both written and visual messaging. 

  1. Branding and Marketing

If you are trying to build a personal brand or are working in private practice, graphic design is going to help you build your client base. Private practice entrepreneurs and/or anyone developing a personal brand must be able to reach their target audience. This is done through marketing, and is most effective when done with a set of specific messages and expectations about that brand. Logos, handouts, and materials that are easy to understand and that showcase personality, knowledge, and trust are necessary.

  1. Making Yourself Stand Out

If you feel that there is a need for some type of graphic or educational material at your facility or worksite, then you have the power to fix that! And people don’t necessarily know what they are missing until they see it. Be the person to create that missing piece or educational element and bring it to your facility’s attention. It’s going to make you stand out as an employee, and seem like a worthy candidate when looking for that promotion.

A Few Design Tips I’ve learned:

  • Simple Message – Overall message should be direct, clear, and specific.
  • Color – Colors should be pleasing to the eye, set the mood, and lead the eyes to important content.
  • Font Size – Consider your audience. Older adults will need larger font size. Text that is easiest to read will be dark on a lighter background.
  • White Space – Don’t overcrowd graphics. White space is essential, and if lacking, can make content unappealing.

Wrapping it all up…

Learning how to make graphics can be time consuming at first, but definitely becomes easier with practice, trust me. Start practicing now! Think about creative ways that you could enhance your work. Despite being so busy with all my projects in school dining, the rotation remains one of my favorites. I really did enjoy making all the nutrition-related graphics; it was kind of relaxing! I liked having a physical, final product of my labors and it feels great getting commended for my creations. Graphics are necessary materials in the field of nutrition messaging. How can you play a part in their creation and use?

Getting Comfortable with Being Uncomfortable

By: Sina D’Amico

It’s funny how when you start college you are surrounded by new people and places, and over four years you become comfortable; then, post-graduation you once again must begin the same process. As my internship got underway, I found that this unfamiliarity also applied to the learning environment. I had just spent four years in college sitting in a classroom learning what I could theoretically say and do in various situations.  This mentality is also applied to your learning environment. The four years of college are spent sitting in a classroom learning all of the “what if” situations that could arise in the field without ever actually experiencing those in person. As a student studying dietetics in college, the core classes focused on implementing medical nutrition therapy in a clinical setting (aka a hospital). Much of my undergraduate curriculum focused on various disease states and how adequate nutrition could be the determining factor in the management or recovery of the specific disease. I was prepared to spend the majority of my dietetic internship immersed in the world of clinical dietetics.  The internship is all about getting hands-on experience; taking the theoretical knowledge learned in school and applying it to real, live patients. However, for how uncomfortable I would be in a hospital and talking to patients. I didn’t want anything to hinder my learning experience.

As I walked into my first day of orientation, which just happened to be at a hospital, I was excited about the next 10 months of rotations. I was oblivious to the fact that I could have to start my rotations in a hospital. Although I had not received my actual schedule yet, I was confident and ready to learn more about the different roles of a dietitian. Then it happened: I looked at my rotation schedule and I was set to start in clinical the following week. My calm, cool and collected demeanor immediately switched to feeling anxious and panicking in a matter of seconds. Luckily, that day of orientation just so happened to be at the same hospital where I would be for my clinical rotations – St. Agnes Hospital in Baltimore, MD. Because of this, I was able to meet the dietitians that day, which eased my nerves. Each of the three dietitians assured me that there was nothing to worry about because they were there to answer all of my questions – that did NOT stop me from worrying for the entire next week.

Fast forward one week to my first day of clinical, to say that I was sweating with nerves would have been an understatement. I began shadowing my first preceptor in the Intensive Care Unit (ICU). The critical condition of the patients did not help; my fear of making a mistake added to that uncomfortable feeling. I continued that day observing her interactions with patients and interdisciplinary team members, trying to obtain as much information as possible. I left that day unsure about how the following 12 weeks would play out. My mind was moving at 1,000 miles a minute and was filled with endless questions regarding my ability and, ultimately, my career choice. What would the following 12 weeks hold? Would this anxious feeling ever disappear? How would I be able to talk to patients about their diets when they had much bigger medical problems to worry about? 

The days went on and I found myself being unable to shake the anxious feeling that was looming overhead. Then it happened: it was time for my first solo interview with a patient. I had watched my preceptor do this exact thing countless times and knew exactly what I wanted to ask to obtain the information I needed. I started off strong, but then lost my train of thought halfway through and started to panic. Thankfully my preceptor was in the room and jumped in while I collected my thoughts. After we exited the room, my preceptor assured me that I would get more comfortable as I got more experience conducting patient interviews. But would I really?

My rotation went on and I continued interviewing patients. Some got better while others remained uncomfortable and awkward. The dietitians kept up their encouraging words stating that feeling comfortable and confident comes with practice and experience, everything that I was there to learn. This feeling was extremely discouraging for me. I had experience speaking with clients and patients so I was unsure why I was struggling with it in this setting. The more I thought about it, I began to realize I had never spoken to anyone in a hospital setting before. My experience was with speaking to athletes right before or after practices who were always smiling and did not have to worry about anything besides performing their best. I had never been in an environment where patients were being bombarded by countless doctors and nurses and also having a dietitian questioning their eating habits. And in many cases, their nutrition was the last thing these patients were worried about. The more I let myself think about how uncomfortable I felt in these situations, the worse my patient interviews would go.  I decided that changing my mentality around the situation might actually change the situation itself.

When it came time for my final weeks with my last preceptor, she talked about how she often got nervous during patient interviews with the dietitians looming over her shoulder in the rooms. Because of this, she wanted me to go into the room alone while she waited outside. I took a deep breath and instantly felt my nerves wash away as I walked into the patient’s room alone. I conducted my interview, still having a couple of hiccups, but not feeling nearly as uncomfortable as I felt in the previous weeks. My preceptor asked how that went as soon and I walked back into the hallway. “A lot better than all of the other ones,” I was happy to report.

My preceptor, Stephanie and I unintentionally matched outfits during my rotation

We kept this up for the remainder of our time together and I finally started to notice a difference in my confidence in patient rooms. Instead of thinking about how I couldn’t mess up because the dietitian was standing right behind me, I started focusing on my conversation and making it more personal to each individual. Instead of feeling nervous walking into a room, I was confident and ready to tackle the questions I had prepared to ask. I had come a long way from the first day when I could not have imagined ever feeling comfortable enough to conduct an interview alone.

I wouldn’t take it as far as to say that I was completely comfortable with interviewing patients in a clinical setting. However, I was confident in myself and my ability to hold a conversation and share appropriate information. The location of the conversation is not as important as its content. Whether it be in an outpatient office, on a soccer field, or in a hospital room, the premise behind each conversation is similar. You want to learn about your patient or client and relate to them so they will open up to you. So that’s what I did. I learned to get comfortable with being uncomfortable, and it worked. 

Now, here I am, finished with my clinical rotation. I survived my staff relief without any problems. I know that I am capable of adapting and getting the job done. These last 12 weeks have been a rollercoaster of emotions but have taught me many valuable lessons about my own ability and the confidence I  have in myself. It’s completely normal to feel uncomfortable in a situation, and that feeling might not quickly go away. When this happens in the future, I will lean into it, grow and develop and get comfortable with being uncomfortable. Sometimes that just might be the only answer.