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.

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.

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".

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!

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!

Lobster!

Dumping Day: November 29, 2011

Since I am doing my internship in a location where the main industry is fishing and lobstering, the other interns and I have been taking advantage of this and participating in as much as we can! 

Lobstering boats ready to depart

Our first lobstering event was Dumping Day. What is Dumping Day, you ask? It is the first day of lobster season when all the lobster fishermen head out on their boats at 6:00am and dump their lobster pots for the first time that season. On November 29th, we three got up crazy early for a Tuesday and were at the Cape Forchu lighthouse for 5:00am. There was a breakfast of bread pudding (incredible), muffins, coffee, and hot chocolate available for donation inside the lighthouse. There were gobs of people waiting outside to see the lobster boats approach the lighthouse. Then, at 6:00am, the horn blew and all the boats increased speed and headed out to sea to applause, cheers, and a message illuminating the rocks on the shore: "Have a safe and prosperous season". It was really great to experience such community spirit and camaraderie! Definitely worth getting up so early - and we were back to the residence in enough time to allow an hours nap before heading to work.

Eating lobster that was caught earlier that day

The next lobster inspired event happened just last night. Tina and I were invited over to our friend's parents home (who live in Pubnico, NS - about a 35 minute drive from Yarmouth) for a fresh lobster feast! Our friend's dad is a lobster fisherman and brought in the lobster from sea just hours before! It was by far the freshest and most tasty lobster I have ever tasted! I was even given a lesson on how to shell the lobster like a pro! 

It was an amazing evening filled with good food and great company! It also put me into the Christmas spirit so I am even more excited to fly home to Calgary for Christmas!

Oh Public Health, What Great Things I Learned During My Time in Thee

So this post is a little delayed due to mass amounts of internship-related work, but here is my final reflection of my public health rotation.

My Office in Public Health

 My rotation in Public Health: 

• Forced me to expand and alter the way I think – think about the bigger picture.  
• Increased my familiarity, comfort, and knowledge in Excel, PowerPoint, Word, and Publisher.
• Allowed me to participate in activities outside of meetings and committees and resource building that Public Health Nutritionists are involved with.
• Meet new people and see parts of Nova Scotia I wouldn’t have otherwise had the opportunity to see. 

Food Service Assessment Project

• Increased my knowledge and experience on how to quickly build rapport (and the importance of doing so) in getting genuine responses.
• It helped me to become familiar with the Food and Nutrition policy so I could better recommend required supports for schools to help them with their efforts to follow the FNP.
• Helped to increase my confidence level in myself and in my background in food service. It felt good to have my preceptors ask me questions to clarify food service-related questions they had. 
• This rotation exposed me to presenting on behalf of a department such as Public Health. It is much more different that a University setting – a necessary and interesting learning experience. 
• I learned so much about prenatal and breastfeeding (nutrition and otherwise). This is an area where I had had no exposure outside the classroom and the prenatal nurse was incredible as a teacher. I was able to create documents, do presentations, help out with prenatal classes and Friendly Feeding Line meetings. I enjoyed having an active role in my education.
• I really enjoyed going on a home visit with a Home Visitor. I hadn’t known that this program existed prior to this rotation, so it was a huge learning experience for me.
• Getting to know the staff of Public Health and meeting with most individually to hear about their roles in the department. 
• Learn about and create documents for the Child Care Regulations – worked with PH Nutritionists province wide for edits. These documents are now being circulated throughout the province. 

Everything hinges on education. Without it, you can't advocate for proper health care, for housing, for a civil rights bill that ensures your rights.

~Susan L Taylor