Infographics and Outreach

By Frances (Fran) Miller

While in a rotation with Maryland Food Bank, I was able to refine my skills in creating infographics and writing. It was important to understand my audience to create an end product that suited them best. By creating a product targeted towards a specific audience, the information can be both applicable and interesting to your audience. 

MFB provides food but also helps clients make healthy informed meal decisions. Infographics are used to provide important health information in an easy to understand format. These infographics are distributed in tandem with recipes; each infographic focuses on a component of the recipe it is paired with. While in my rotation at MFB, I was tasked with creating infographics that helped inform and entice participants to use the knowledge provided in making future decisions.

While creating these infographics, I was able to learn more about the community they serve. It was difficult at first to predict what reading level and topics would best suit their average participant. For example, I created an infographic for peanut butter. Knowing that this is a common allergen, I wanted to mention some alternatives for those unable to eat peanut butter. After doing some background work, I later realized alternatives to peanut butter would likely be too expensive for many of MFB’s clients. I later applied this knowledge to avoid costly alternatives when making an infographic about dairy.

To ensure the text was easy for participants to read, I began using an online tool to assess the reading level of my writing. I then adjusted my writing to make my infographics more accessible. I also added additional recipe ideas that I sourced from the supplemental nutrition assistance program (SNAP). I used SNAP because they create recipes that use just a few inexpensive ingredients and basic kitchen equipment. 

This experience taught me to gear my language and content to my target audience.  I learned to strike a balance between under and over estimating clients’ knowledge base. If I overestimate how much they know about the topic, the infographic would be too difficult to understand and would be inaccessible. If I underestimate the clients’ knowledge, they won’t learn anything new and may even be insulted. Either way, the infographic will not serve its intended purpose.

Through this process, I was able to better understand my audience to create a product that would be accessible and helpful to them.

 

Behind the Scenes of Maryland Food Bank

By: Rachel Eldering

What do you think of when you hear “food bank”? Maybe you think about large donations or volunteering to sort food. That’s what I thought of before interning with the Maryland Food Bank. My experience, however, showed me an organization that does so much more. My main undertaking while interning at the Maryland Food Bank was to write a preliminary research paper on senior hunger in Maryland. This was my first time creating a research document and presenting it in a professional setting. 

The purpose of this exploratory research was to determine if and where more senior specific nutrition programs are needed in Maryland. My goals were to get a better understanding of where the seniors reside, what senior-specific nutrition services are currently being used and where there are gaps in service.

An example of a CSFP box provided to seniors.

The process of this project was a bit challenging for my type-A personality. Since this was a preliminary project, there wasn’t a strict set of guidelines to follow. Making some assumptions and judgements on my own ended up being a great way to grow my confidence as a novice professional.

The first step in my research was to scour the internet for data on seniors and hunger in Maryland. I sifted through a lot of data looking for solid, specific information on the target population. I found some great information from the Census Bureau and the Maryland Food System Map. Additionally, much of my research came from interviewing employees of the Maryland Food Bank and Maryland Department of Aging. To best complete my research, I needed to talk with professionals who are knowledgeable about the hunger needs in Maryland. Maryland is split into 5 regions: Northern Maryland, Western Maryland, Eastern Shore, Central Maryland and Southern Maryland. Each area has different obstacles and hurdles to address. Maryland Food Bank employs five Regional Program Directors (RPDs), one for each region. It was imperative to speak to each of these RPDs as they are experts in their region’s hunger challenges. By speaking with each RPD, I was able to get a feel for the counties and towns that have a higher senior population and struggle with hunger. Each RPD provided great information and input on where they felt there were gaps in nutrition services in their region. Additionally, I met with a few employees of the Maryland Department of Aging (MDOA). In my research I needed to outline senior nutrition services that are currently in use so I could form a clear idea of what exactly is lacking. The MDOA provided insight on the impact of COVID on their nutrition services and what their funding looked like. This gave me a better view of how services have changed since March and how they are looking as we enter the new year. Finally, I was asked to include a map data visualization to communicate my findings most effectively. The Maryland Food Bank has a hunger map on their website with a plethora of layers. Some of these layers include the population below the federal poverty line, pounds of food distributed by MFB, and population below ALICE. The acronym ALICE stands for Asset Limited, Income Constrained, Employed and is a new method to define families that live above the federal poverty line but still struggle to meet basic needs. I met with the Vice President of Learning, Measurement, and Evaluation two times to help brainstorm what layers could be added to the map to strengthen the research. He worked to put those layers onto the map and later showed them to me so I could use them when I presented to the Senior Vice President of Programs.

The Maryland Hunger Map helps visualize areas of Maryland with high populations below the Federal Poverty Line.

After all my meetings and research, I was able to put together a nine page report on all my findings and present it to the Senior Vice President of Programs. First, I summarized how well the senior hunger need is being met right now. Government funding, like the Coronavirus Food Assistance Program and the CARES act, has increased since COVID in an effort to aid in this crisis. So, hunger needs are being met fairly well at the moment. However, there is concern because a lot of this funding will end at the start of the new year. Members of the MDOA and MFB are unsure how well the need will be met in the coming months. Next, I made a list of hunger hotspots that needed more attention. I made this list based on my conversations with the RPDs and data I found online. The main areas of concern were East Baltimore City, Somerset and Allegany County. Baltimore City has the highest percentage of food insecure individuals in Maryland. East Baltimore, compared to the West side, has fewer partner sites that distribute food to senior programs. Somerset county has the second highest percentage of food insecure individuals and the second highest percent of seniors living below the federal poverty line in Maryland. Allegany county also has a high percentage of seniors living below the poverty line. Furthermore, it is rural and has areas with limited access to affordable and nutritious foods. There also are very few partner sites that distribute food in Allegany County. People can live up to 40 miles away from the nearest grocery store, so creating central food distribution sites is a challenge. 

Finally, I offered some ideas that could potentially aid in senior hunger. One solution to provide more assistance became clear: better transportation. Baltimore City does not have great public transportation and rural areas don’t have a system at all. Additionally, it’s likely that seniors have problems accessing transportation no matter where they live. In order to help seniors there needs to be a better way to either get the food to the client, or the client to the food. 

Overall, I received positive feedback on the completed research paper. I’m hopeful that it will aid Maryland Food Bank as they provide healthy food to seniors, when and where they need it most. I learned so much during my time at the Maryland Food Bank. My biggest takeaway would be the importance of working with others. I learned so much from getting input from knowledgeable stakeholders. It taught me the importance of collaboration and teamwork for producing the best outcome.

“It is All a Part of the Process”

By Linh Nguyen

A former coworker of mine used to say to me, “It is all a part of the process.” I believe those words are a foundational truth that can be applied to almost all aspects of life. My dietetic internship experience started off with my clinical rotation at Sibley Memorial Hospital in northwest Washington, DC. Learning to review a patient’s electronic medical chart, interview the patient, perform an adequate nutrition focused physical exam when necessary, determine the nutrition care process, and finally capture it all succinctly in a note is most certainly an evolving process for me.

Becoming familiar with and adept at utilizing the electronic medical record, Epic, was one of my first important tasks as an intern at Sibley. Overall, I found this cloud-based application to be very customizable and intuitive for users. Fortunately, my preceptor helped configure my Epic account to easily access relevant information and data. Epic stores and displays information in a multitude of ways, and it is just a matter of remembering where and how to access the data you need. I can say learning Epic was the easier aspect of the clinical rotation for me. Learning what pertinent information and data are needed to adequately assess a patient’s status and nutritional needs requires a level of judgement that, with practice, I have developed. Fortunately, my preceptor provided examples of formatted notes that can aid in this process. I initially wrote down a list of information I need on a patient to make sure I am not missing anything, seen here at the bottom, middle part of the picture.

Interviewing the patient and/or family members is another important part of the process. Some patients are easier to interact with than others. I empathize with the fact that many patients are in pain, are scared, do not want to be in the hospital, and are suffering immensely. Other patients are simply unable to physically talk or are not mentally sound so cannot provide adequate information. Still, other patients are happy for the visit and are engaged. In the beginning, I made sure to follow my checklist of information I needed from the patient to ensure I did not miss anything. This approach made me seem undoubtedly robotic to the patients. Observing the preceptors having a conversation with patients while gaining pertinent information helped me see how to interact with patients in a more natural and fluid manner. Over time, the process of interviewing patients has become less effortful and more natural for me. I have become more comfortable gathering the information I need from the patient and believe the interactions are smoother and more comprehensive. Again, this part of the process improved with practice.

The nutrition focused physical exam (NFPE) is an indispensable skill that clinical dietitians need to be comfortable and adept at performing. I was able to perform the NFPE on several patients during this rotation. The first and most important thing about performing an NFPE is gaining the patient’s consent. If a patient would rather not have the NFPE performed on them, I tried to look at the patient from various angles and at different parts of their body to see if I could visually assess for fat and muscle wasting. I typically told the patient what part of their body I would touch before I touch it. A patient’s possible limited mobility, any lines or equipment attached to various parts of the patient, and their body posture in the hospital bed dictates what area of the patient’s body I could assess. Another important aspect of the NFPE is to try to assess what is “normal,” or the baseline body type for a patient before the illness occurred, to be able to determine how the patient’s body has changed over a defined period of time. Documenting evidence and data that are undoubtedly facts about the patient are necessary to diagnose for malnutrition. Two of the resources I used on almost a daily basis are the Nutrition Focused Physical Exam Pocket Guide and the Academy/ASPEN’s criteria to support a diagnosis of malnutrition.

The last part of the nutrition assessment and intervention part of the process is documenting it all in the note. At the start of the rotation, my notes were choppy and not comprehensive. I should have been embarrassed if I knew any better! Throughout the weeks of reading the dietitian’s previous notes and the notes of other healthcare providers, I gained a sense of correct verbiage, acronyms, and data needed to complete a note. I gained a sense of what information I needed to document and in the correct fashion. With time and practice, my note writing skills developed.

Collaborating with other members of the health-care team and revising nutritional needs based on the patient’s clinical course and plan of care are important parts of the process as well. After speaking with the patient, and sometimes the nurse and/or a patient’s family member, I thought I had all the information I needed to create a nutrition care plan and to write the patient’s note. Although, a sudden change in a patient’s plan of care updated from a doctor or nurse may require changing the nutrition intervention as well. (For example, a patient has just been extubated and is no longer receiving propofol, or the doctor no longer plans to initiate tube feeding). It is all a part of the process!

Dining Services from all Perspectives

By: Caty Saffarinia

Food trends are evolving and there is a rise in food allergies. This presents a challenge to universities, where students tend to be adventurous eaters. I am grateful that I was able to work with the University of Maryland’s campus dining services team as they strive to find the best methods of feeding their students while offering more variety. Campus dining services was a great introduction to how to run food services for a large university. Before starting this rotation, I did not know about the rules and regulations nor all the participants needed to run a large-scale dining service operation. This rotation taught me how to order food, receive deliveries, store food properly, prepare and cook the food, serve the food, and manage the whole operation.

My internship partner, Sina D’Amico, and I during our Campus Dining Services Rotation

My internship partner, Sina D’Amico, and I during our Campus Dining Services Rotation

The dining services managers order food every day, Monday through Friday. Before ordering, they review the menus and take inventory so that they order just enough of the foods they will need. One of my responsibilities was to check the food that was delivered by comparing the list of food ordered with the invoice of deliveries and the boxes of food. I think the most challenging part of receiving food deliveries is checking to make sure we received all that we ordered. Many employees mentioned that it becomes much easier when you become familiar with what the food packages look like. Another responsibility was to check the temperature of refrigerated and frozen foods. Once everything was checked, the deliveries were put away in appropriate storage areas, freezers and refrigerators.

To get experience serving, I worked at the sandwich station in the South Campus dining hall. A  student employee showed me the location of the ingredients I needed, how much meat and cheese to use for each sandwich, and how to heat the sandwiches in the oven. I interacted with students and employees during this experience and now understand how to stay organized and delegate tasks when there is a bigger crowd. The students were all very polite to the servers and also were very patient. I appreciated this since the foodservice employees worked hard and took pride in their work. 

Following my serving experience, my internship partner and I shadowed one of the campus dining service managers to observe what this role entails. Then we took a turn at managing the kitchen, making sure everything in the kitchen and dining hall were running smoothly. We ensured the milk was labeled correctly with dates of expiration and that foods were kept at the appropriate temperatures. As managers, we monitored the food being served and observed the employees and students to make sure the food was being handled correctly and the students were getting the food they wanted. Additionally, we inspected the kitchen and dining environment. For example, we looked for flyers posted around the dining hall which didn’t have prior approval from dining service managers. I learned that managers have a huge responsibility; they must organize, supervise, and delegate tasks to employees appropriately. 

This rotation built on my prior education and work experience and helped get me ready for my upcoming 6-week food service rotation. By performing the duties of the foodservice manager and a dining hall food server, I saw different perspectives and gained much experience. A lot goes into making a dining hall run smoothly.

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.