Tuesday, July 23, 2013

dietetic internship weeks 1-4: LTC

Every time I think I am settling into a routine, the rug is pulled out from under me. That's the funny thing about internship - you have little time to adjust. You are thrown into new situations at new places with new people and new expectations. It definitely keeps things interesting. 
I just find it SO much easier to stick to my goals (whether it be exercise, blogging, healthy eating, etc.) when I have a routine in place. I already know this is something I'm going to struggle with over the next year as I complete my internship. Maybe my routine will have to be adjusting to new routines ;)

Thanks for sticking by me. I really want to document this experience so I need to make the time.


My first rotation of my dietetic internship was at a long term care facility. Going in, I had no idea what to expect. I had prepared as much as I could by reading the Academy's position papers on older adults and reviewing some important topics (wound healing, dysphagia, etc.) But I couldn't shake the nervous feelings on my first day!

Looking back, I had no reason to be nervous. My site was wonderful and I enjoyed my time there so much. I was lucky enough to work with a great dietitian who really helped me find confidence in myself and my abilities as a [future] dietitian.

Most of my time here was spent performing assessments and charting - which I really enjoyed! As new residents were admitted to the facility we would perform initial nutrition assessments. We would also perform MDS assessments [14-day, quarterly, annual, and significant change] on current residents. 

To start, my preceptor introduced me to their computer system and showed me where they keep their paper charts and let me follow along as she performed an assessment. After that, I worked on my own! To perform an assessment we would gather information from the online chart and nursing notes, refer to the residents paper chart, talk to the resident, and ask nursing about their intake or supplement acceptance. We would often observe meal times as well. At first she was right there with me but by the second week, we would each be assessing separate residents. It felt really good to have that freedom while also knowing I could go to her with any questions. I felt very comfortable saying, "I'm not sure, about _____, could you help me?", but I also felt comfortable saying, "I think this intervention could work for ______." I can't believe how much I learned.

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Here's what a typical day looked like for me during LTC and [What I Wore]:

8:00-8:45 
Morning commute!
9:00-9:30 
All staff meeting
9:30-10:00
Rounds with nursing, physical therapy, and social work
10:00-11:30 
Perform MDS assessments, chart on new admissions, or calculate weight changes
11:30-12:30 
Observe lunch or attend other meetings [each week there was a standards of care meeting and then there were care conferences throughout the week with residents families as well]
12:30-5:00
Continue charting, updating care plans, and MDS.

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LTC Highlights:

- Signing my first note!
- Calculating a real life tube feeding and making adjustments based on cost and other factors that go beyond what you learn about TF from a textbook
- Observing a barium swallow study, seriously this was so cool
- Attending wound rounds. Such an eye-opening experience. It's one thing to read about a coccyx wound on a chart, it's something else entirely to see it. Really helps you recognize their need for PROTEIN and ENERGY!
- Seeing medicine really work for someone. One resident that I completed a case study on had an organ transplant and had severe edema. It was amazing to see this resident lose 25% of their weight [intentionally because of the fluid accumulation] with the help of diuretics and nutrition interventions.
- Attended the Older Adults Protein Needs webinar from Today's Dietitian

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Other Assignments:

Along with internship, we also have classes to take. This summer we had one class for internship and another on healthcare management. The class for internship met once so that we could all discuss our different experiences. I liked catching up with my classmates and hearing what everyone else was up to. For this class we had two smaller assignments. One was to relate information from the Academy's position papers to interventions we were putting into place during internship. The other was the case study mentioned above. Basically we had to gather all the information we could about that resident and put it into a case study format with all of the pathophysiology of their condition along with recommendations for their future care. 

The healthcare management class is an online course. I don't love online classes - I like to hear a lecture on something and then go home to read and take notes so that I can make sense of the information. With this class, all the information is from reading. I have to really focus and go over things slowly to "get it" but I've truly enjoyed this class. It's taught me a lot about being a leader and managing other people through delegation. 

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Phew! I apologize for such a long post but I really got to do and see a lot during those 4 short weeks. I hope this was interesting and helpful to you if you are currently a dietetic intern getting ready for LTC or if you are still completing your coursework before internship. 

If you have any questions for me, please leave a comment!


What was your experience in LTC like?

Thursday, July 11, 2013

treat yo self

It's a weird thing - buying ice cream for yourself, by yourself. 

As my fellow dietetic interns and I wrapped up a meeting at a local coffee shop in Grandview, I wandered outside, feeling the warmth of a summer I've yet to enjoy. See, it's rained 16 out of the last 18 days here in Columbus and I haven't had much time for "fun". 

Noticing Jeni's Ice Cream as I walked to my car, I decided, "Janelle, it's time to TREAT YO SELF!"


Jeni's is kind of the best place ever. Her ice creams are incredible. With flavors like Salty Caramel, Pistachio & Honey, Brown Butter Almond Brittle, and Queen City Cayenne, there is literally something for everyone. 

What I love the most about Jeni's is their commitment to the best and freshest ingredients they can get their hands on. All of their ice creams start off with Snowville Creamery milk and "cream from cows that eat grass." Awesome.


You definitely have room for these treats in your diet. 

Did I mention the best part? Many of Jeni's ice creams are gluten free! And I'll do you one better - she even makes gluten free ice cream sandwiches like the one I enjoyed above. 

You can find the ingredients and nutritional information for everything they sell here.













I feel good about eating this ice cream that I love so much.

At first I felt uncomfortable, sitting alone in the small shop, enjoying my macaroon. Ice cream should be enjoyed with friends, I told myself. But really, ice cream should just be enjoyed. 

I finally found myself sitting comfortably in my seat, relishing the quarter of a macaroon I just got to enjoy, only to look up and see two friends walking in the door.




Tell me: How will you treat yo' self this week?



Wednesday, July 10, 2013

imperfection

Like most dietitians and dietitian-to-be's, I have a "type A" personality. Meaning I am highly self-critical and have to have everything just so. I don't think this is a good thing, by the way, but it is what is. I feel anxious a lot because I set such high expectations for myself. 

I'm telling you this because I've allowed perfection to stop me from blogging, like it's stopped me from so many other things before. I am often paralyzed by the fear of being imperfect, that I don't start. 

How crazy is that?


Hi, my name's Janelle, and I am not perfect. 

No doubt, I've been busier the past few weeks than I have been in a long time. Between dietetic internship, classes, wedding planning, spending time with my fiancé, family, and friends, I don't have much time left for myself.

I've thought about blogging so many times but haven't had enough time to make each post perfect. I haven't had time to craft the perfect logo to place on each picture. I haven't been able to think of new and exciting ideas to post about. And because of that I've been silent.



I don't need my blog to be perfect - I want it to be an extension of my imperfect self. I want it to be real and informative. I want it to document my life and my internship so that hopefully it can help someone else along the way. 

So I am recommitting myself to blogging and promising imperfection. 

I hope to make blogging a normal part of my routine, which could take some getting used to since my schedule feels so full already. Right now, it's about making the time for what's important to me, and blogging is very important to me.


I'll leave you with this photo of me and my matching Starbucks. Matchy matchy.



Tell me: How do you find time for the things you love? 

Monday, June 10, 2013

nervous ramblings of a dietetic intern

It's raining on my first day of supervised practice to become a dietitian. Fellow dietitians, is this a bad omen like some think it is with weddings? Hmmm, but other people think rain on their wedding day is good luck. Personally, I think some days it just rains.

There are 7.2 million results for "rain good luck wedding" in Google but 28.2 million results for "rain bad luck wedding". We are not a very optimistic society. 

Oddly enough there were 64,800 results for this google search:

"what does it mean when it's raining on my first day of supervised practice because I'm really nervous and I spent too much time ironing and making myself look nice for rain to screw it up?" 


I just took that picture and on the computer screen is the draft of this very post. In the mug is coffee. The Keurig gets me out of bed so fast. They should invent Keurig alarm clocks that wake you up and brew a cup of coffee for you at the same time. And yes, my blanket is a Charlie Brown christmas.  

So you're probably getting ready to click the X and get out of this window because I've yet to tell you anything even remotely important. Can we start over?

Hi. I'm Janelle.

Your not-so-typical future dietitian. I'm becoming a dietitian for the money.... fame... health of it. For my own health and for your health. I know first hand how hard leading a healthy life can be. Good health hasn't come easy for me. I love food of all varieties and I've had to learn how to love fruits and vegetables more... for the health of it. For me, that's what it comes down to. 

My high school self would never believe that's a green smoothie in my hand. In fact, my high school self probably wouldn't know what a green smoothie is. But boy would I recognize these...


If we were talking to my high school self, 4 of those cookies would have met my face already. To some, these cookies appear healthy ["they're gluten free they must be healthy!!!"] but a cookie is a cookie is a cookie is a delicious cookie. Just because I have celiac disease and have to eat gluten free does not mean I can drown my woes in gluten free bon bons [do you think those exist? I've never even had a regular bon bon.] 

And that's been my struggle. Choosing the green over the "extra whipped cream". But I show up. Every day. Ready to make those healthy, smart choices. I'm not perfect. I don't try to be. I just show up. That's what I encourage others to do too. For the health of it.


Come back Friday for a recap of my first week as a dietetic intern. My first rotation is at a long-term care (LTC) facility!


p.s. this URL is not set in stone, I'm still trying to purchase "the one". If you want, add me to your feedly and follow along on twitter and instagram!

p.p.s. this blog is still very rough. if you notice anything wonky please let me know in the comments!

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