Sunday, June 24, 2012

Approaching the Finish Line


During the initial months of my internship, I was challenged to record regular reflections on my internship experience. I did routinely do this, however, due to the intensity of the internship not all reflections were documented on my blog or even on paper. Reflecting allowed me to ascertain the learnings I had experienced in my day/week/rotation and enriched my overall internship experience. It is a practice that I will continue upon successful completion of my internship (graduation day is July 20th, 2012 which is also my final day of internship).


Highlights:

§  Public Health

o   Interacting with people from different communities in the District Health Authority (DHA)
o   Seeing and experiencing rural Nova Scotia! Great people and beautiful scenery.
o   Learning the intricacies of public health policies
o   Not an area of dietetics in which I see myself practicing (although, I will not rule out the possibility), but I have enormous respect for Public Health Nutritionists and the complexity of their roles with public health.

§  LTC

o   Participation in resident special activities: Christmas teas and Christmas concert
o   The comfort I felt in the role and excitement I had going to work daily. I really enjoyed being amongst the Residents, staff, and other health professionals. Definitely an area I would love to work in.

§  Clinical

o   Increasing comfort level with enteral and parental nutrition prescriptions. I am proud to say that it did not take me the better part of an hour to write out a total parental nutrition (TPN) prescription by the end of my 13 weeks. Furthermore, I, most importantly, became trusting of my eduction and knowledge and what I wanted to recommend for patients. Confidence in my skills grew over the course of my 13 weeks in clinical (+ 1 week in the Diabetes Education Centre).
o   Increased comfort interacting with patients and providing diet education.
o   Observing the dietitians during patient and family interactions. Learn tips and tricks in diet education and various ways to interact with patients and their family. I learned methods that I'd like to emulate in my practice, and methods that I will try to avoid.
o   Working with the Speech-Language Pathologist (SLP) for swallow assessments and Modified Barium Swallow tests.
o   Interprofessional Learning Experience (IPL) - which I blogged about previously. I was also given the opportunity to co-facilitate an IPL team. Which I found enormous benefit in - but this I speak more of in my "Most Significant Learning Experiences" section below.

§  Administration/ Food Service

o   Co-facilitating IPL
o   Program planning and implementation
§  Completing projects and assignments relevant to the workplace
§  Collaborating with interns from other DHAs for projects.
·         Admin - Patient satisfaction survey; food service staff information session on NS Healthy Eating Initiative: Salt by Request provincial TeleHealth session.
o   Participating in dietitian and food service supervisor interviews
o   Conducting reference checks for interviewees
 

Most Significant Learning Experiences

§  My most significant learning experience occurred when speaking with the other dietetic interns in the DHA who recently began or returned to complete their internships. I found myself enjoying sharing what I had learned and instructing them on certain topics. I got excited when they got excited about internship and what they too will learn. I hadn’t before experienced the joy that came with sharing my knowledge and it made me excited for when I am a preceptor for an internship program. Additionally, co-facilitating the IPL team in oncology and palliative care was a great experience. This spring there were two IPL sessions running simultaneously. A stroke team and an oncology/palliative care team. Disciplines representing in the entire group included: SLP, dietetics, nursing, occupational therapy, diagnostic cytology, and respiratory therapy. I was eager to plan the team meetings and search for resources for the students. I enjoyed hearing them reflect on the multidisciplinary rounds they attended and of their experiences in the hospital. I believe that I will really enjoy the preceptor and instructor component of being a dietitian.

§  The importance of a supportive environment
o   Research results: my internship research  projects focused on factors that contributed to a supportive environment for the Food and Nutrition Policy for Nova Scotia Public Schools.
o   Experiences in internship with preceptors and other health professionals
§  Majority of my preceptors fostered learning: encouraged me and gave me a push when I needed it. When I wasn’t provided with the supportive environment, I felt initially discouraged, then used it as fuel to try and excel to show me, not the preceptor or other health professional, what I was capable of when I only had myself to depend on.
 

Unexpected Learning Events

 §  DC National Conference
o   Interactions with others
§  How I treat others and how I want to be treated. Respect!
§  Perhaps it is because I am naive and want to think the best of everyone, but I was taken aback when conference delegates didn’t want to interact with me aside from the basic “I’m from ___” (which seemed to usually be just the province, not city or town) and then stopped the conversation with that.
§  Additionally, I was surprised by an encounter with a dietitian whom I had met previously and corresponded with. I'll spare you the story, but the situation definitely took me by surprise and solidified in my mind that I will treat each person with respect and make an effort to remain positive despite how I am feeling that day, even if someone is being rude to me. I’m not certain why I was regarded with such disrespect, but I know that I will take it as a learning experience for the kind of professional and person I want be.
§  With that said, there were many dietitians whom were eager to interact even if just briefly. I went to the Conference with a goal of meeting as many new people as I could – and was delighted when people took an interest in me as well. I believe that professionally, networking is key in an ever-changing profession such as dietetics. I was delighted to discover that the majority shared this belief and practice. The conference itself was so much fun! I really enjoyed seeing Acadia University alums, made some new friends and acquaintances, and learned a lot from the sessions (educational, key note speakers, and research displays). I'm so grateful that I was given the opportunity to attend (I received sponsorship from the Gerontology Network of Dietitians of Canada as a student member - I applied, they granted).



§  Discussing my casual position with a friend, I was explaining how I deescalated an angry principal who thought I had the power, and the intention, of closing down the school’s cafeteria. As I was explaining the situation to this friend, I could hear the difference in my approach to the situation, in comparison to when I initially started my internship. My friend pointed out this change as well. I let the principal express his concern fully and when he was finished calmly responded. I told him that he is not alone with his concerns and that I had heard them from numerous principals in schools I assessed (which is true). I then explained that I have no intention, or capability, of saying or doing anything in regards to whether the cafeteria remains functioning. My job was to ask questions and to observe the food service workers do their jobs so that I can find ways in which the school board and public health may be able to help them comply with the NS Food and Nutrition Policy. I let him know that I was in the school simply to find ways in which we could support the food service workers in their role. So quite the opposite to shutting down the cafeteria. This conversation showed me how far I have progressed in my education during my internship and was a real "ah-ha" moment for me in my internship.

Challenges I Encountered

 §  Trying to keep sane while completing all internship assignments and projects up to my standard of quality.
o   Organization is important! Throughout my career as a student in both culinary school and at Acadia University, I started projects and assignments as soon as they were given to me. I did this in case something came up in the future that would limit my time available to complete the project and do so well. In the past, the quality of my work declined when it was completed close to the due date, so I knew to not leave assignments to the last minute. In my internship, I continued to start and complete assignments as soon as possible, however, the timelines and due dates got shorter and the quantity of work increased immensely. I found that I was able to rise to the challenge and produce high quality work in short periods of time. My stress level was high, but I’m proud to say that I not only got through it, but received positive feedback from my preceptors on my assignments/projects.

Key Message I Learned During My Internship

§  A supportive environment in which to learn and to teach is important and I believe a key to success and satisfaction in one's position – whether it be a professional environment such as the workplace or social environment. I will strive to obtain and maintain a positive and supportive environment in which co-workers (and myself) can work together and where students feel supported to learn, ask questions, and most importantly, feel that it is okay and accepted to make mistakes. 

I only have 4 weeks remaining in my internship and I know that they will fly by. I am grateful for this internship opportunity and even more grateful that I was able to do it in SWNDHA. My preceptors were knowledgeable and supportive, I got to see and experience areas in NS that I wouldn't otherwise have had the chance to, and I feel prepared to enter the workplace as a dietitian. I have started applying for jobs in Calgary, AB and even have had a couple interviews this past week. I am excited to start my career!


Thanks for reading!


Wednesday, April 11, 2012

So Much to Reflect On...

So... apparently I've fallen behind on my blogging - but have still kept up with my personal reflections, I just haven't documented them here! I have a lengthy list of topics that I will be blogging on in the not-too-distant future once I get on-top of my projects, assignments, and reports.

Until then, here are some smiles that I've found over the past few months whilst searching for much needed giggles. 







Sunday, January 15, 2012

Renal Dialysis Unit


This past week marked my first pre and post hemodialysis clinic in the Renal Dialysis Unit (RDU) in the hospital. What a pre and post day includes in that the dietitian (and myself) go to the clinic three times (10:00, 14:00, 19:00) on Wednesday and Thursday to see the hemodialysis (HD) patients. For those of you whom are unfamiliar with dialysis, here's the basics: depending on how often each patient needs to have HD, depends on how many times they need to go to the clinic to have their blood cleaned (remove PO4, K+, fluid, add calcium, etc. depending on the individual - i.e. not everyone will have fluid removed or calcium fortified above the norm). Some people go to the clinic three times a week (M, W, F), some go four times (M, W, F, Sat), or some can go twice (T, Th). It all depends on what the nephrologist determines would be best for each individual patient. There are different start times in the RDU for HD, which is why the dietitian and I went at three different times each day. This allowed for the patient to be set up on dialysis and for their pre-dialysis blood work to be returned from blood services.

What the dietitian and I did while we were in the RDU: we looked at the patient's pre-dialysis blood work (urea, creatinine, phosphorus, potassium, calcium, magnesium, and albumin), wet weight, dry weight from the previous HD day, and ask the patient how they have been doing in regards to eating (compliant with individualized renal diet?), if they have been or are on any phosphate binders such as Tums or Renegel (which help to bind the phosphorus in foods that are eaten to reduce the phosphate load in the body) and when they take them if they are on them. We asked how their bowels are doing, if they had any nausea or vomiting or illnesses over the past month (which could have an affect on their blood work and weight), any supplements taken (Nepro, Ensure, Glucerna, Boost), if medications have changed (we also check in the chart to verify), and provide encouragement or diet education when required. It is quite the busy time going from patient to patient - seeing ~ 4 or 5 patients in each time slot, then charting on each one.

I was able to the various routes of HD, i.e through a central line access or through fistulas made via surgery in the arm (fusing together a vein and an artery to help the vessels handle the increased blood flow when the blood is being pumped out of and into the body). I was able to see a very interesting patient who had a fistula in his left arm, but had multiple aneurysms in his arm that throbbed and pulsated. I asked the nurses if this was common, and apparently it is. Patients can be given a protective sleeve to help protect the aneurysms, but usually the patients just try to be careful.

I found it very interesting to see the HD machines up close, look at the lab values of each patient, and to speak with the patient regarding diet compliance, medication compliance, and chatting with each patient. Because the patients do frequent the RDU numerous times a week, a rapport is able to be established whereas with in-patients in the hospital, this is difficult as they are only in hospital for limited amounts of time.

While in the RDU, I was "tested" on my knowledge of the nutrient content of foods (phosphorus, sodium, potassium) as well as on my knowledge of renal and diabetic diets. I learned a lot about ideal lab values for dialysis patients vs. pre-dialysis patients vs. the average healthy population. Very interesting and educational experience.

Saturday, January 14, 2012

Interprofessional Learning Experience


This past week marked the first of 5-weeks that I will be involved in an Interprofessional Learning (IPL) Experience. 

What is IPL?
"...it provides opportunities for learners from two or more disciplines to learn with, from, and about each other to improve collaboration and the quality of care" (CAIPE definition 1997 revised).

The different students that I will be working with over the next 5-weeks are from the following disciplines: nursing (2 students), recreation therapy, pharmacy, and dietetics (me!). We're a group of only 5, but I can see from our first meeting that we'll get along very well and each are driven to get as much out of the experience as possible. We meet twice each week: once on Wednesdays over lunch with just the 5 of us and two instructors (one from nursing and one from dietetics), and then we all attend stroke rounds Thursday afternoons. On February 10th, we are to present to a group of people from various disciplines, including our individual preceptors, regarding our experiences in IPL. I have an idea for the presentation, and I'm eager to bounce it off the other IPL members next Wednesday to get their input and opinions on it.

In our first meeting, January 11th, we had an activity where our disciplines were written on large white paper and stuck on the walls. We were then to go to every discipline but our own and write down the roles and responsibilities of each. Well, I had thought I had a good understanding of what nursing, pharmacy, and rec therapy professionals do, but I clearly only knew the basics. This activity was the first, of what I believe, will be many educational opportunities that I will experience over the next 5-weeks. I have no doubt that this group will provide me with a better understanding, respect, and appreciation for allied health care.

My experiences working with multiple-disciplines has not before been with a group of students, but rather with me being the only student amongst a group of professionals. In the different facilities and hospitals that I've either worked in or volunteered with, this has been the case, so I hadn't before had the chance to ask questions regarding roles and responsibilities of other disciplines (in a comforting and supportive environment). I am excited to see what unfolds over the next 5-weeks and to assess my own personal mental and creative growth that I know will occur during the IPL experience.

Sunday, January 08, 2012

New Year, New Rotation

Handy book I was given for Christmas.
After a fantastic Christmas at home, in my new home, I am back in Yarmouth and have finished my first week in my Clinical rotation. I am currently in the area of stroke and renal and I anticipate learning a lot over the next 4-weeks.

Each week there is an assignment to complete. Week one's was focused on dysphagia, aspiration, and the dysphagia diet. Week two's is more in-depth focusing on protocol, what to look for when doing swallow assessments, etc. I have yet to read through week 3, but will let you know in the not-too-distant-future.

So here's a recap of my week:
Tuesday and Wednesday I essentially observed and answered questions the P.Dt. asked me. On Wednesday, however, I got to see my first Modified Barium Swallow which is a video x-ray of a person showing how they swallow (ie. the physiological function of the muscles, how well/easily/safely the food is swallowed or aspirated) to determine if they are safe to have food by mouth (po) or if they should be NPO or nothing by mouth. I had seem YouTube images before and recordings of MBS' in school, but seeing it live was so interesting! Hearing the Rad. Tech and the Speech-Language Pathologist and the Dietitian discussing what they saw on the screen, each inputting their own specialty wealth of information, was really impressive to witness. Thursday I started charting and having a more active role, and by Friday I was charting, calculating tube feeds (rate, formula, and energy, protein, and fluid requirements of the Pt.), and interviewing patients. I know that this week is going to be even busier so I best keep on-top of my studying to keep all the information fresh and "at the ready".

Wednesday, December 21, 2011

Happy Holidays!

Today is my second last day in my LTC rotation and to say I have enjoyed myself would be an understatement. I met some really interesting and intelligent people (staff, Residents, health care providers, Resident's friends and family, etc.) during my time at the Villa and I feel that my experiences in this internship rotation were enhanced by these interactions and they allowed me to grow in knowledge, experience, skill, and emotionally. Being a LTC Dietitian allows for so much more than providing nutrition and administrative assistance and leadership - it comes with an opportunity to bring joy, comfort, compassion, and a supportive ear or shoulder to the Residents. I would welcome the chance to have a career in LTC.

With the end of my rotation in LTC, comes some much needed time away with my fiance, Kev! I am so very very excited to fly out in the wee hours of Christmas Eve morning to join him for the holidays.

My next rotation, starting January 3rd, 2012 will be in Clinical with a Renal/Stroke Dietitian.

Merry Christmas and Happy Holidays!






Tuesday, December 13, 2011

Rotation #2: Long Term Care

Villa Saint Joseph-Du-Lac
I have now finished my first 2 of 4 weeks in my LTC rotation and I can honestly say, that I am loving it! Prior to this rotation I did have experience working in LTC facilities (in Lunenburg, NS; and Calgary, AB) so I knew that being in this setting was something that I enjoyed and thrived in - and this continues to be true.

The tasks and assignments that I have been working on include:
  • Admission assessments;
  • Dysphagia assessements;
  • Menu analysis for number of servings daily available to Residents from Canada's Food Guide;
  • Implementation of a new food to the menu;
  • Staff in-service education sessions on "Celiac Disease and the Gluten-Free Diet"
  • Attend multidisciplinary focus meetings
  • Prepare for and present at Resident Care Plan meetings
  • Assist with food-related events, such as a birthday party and Christmas tea;
  • Charting;
  • Prepare and present a detailed case study of a Resident;
  • Assess Residents on nutritional supplements (Ensure, Boost) for means of continuation or cessation;
  • Cost analysis of the nutritional supplements to determine daily, weekly, and yearly cost;
  • Assist Residents with meals ("feeding" - but I hate to use that term so I shall refer to it as "assisting with meals" instead);
  • Resident and staff interviews;
  • SO much more!
I really am enjoying my LTC rotation!

A more descriptive entry complete with my reflections on my experiences in LTC will be completed when I'm at the airport waiting to board - only 10 days remain!